Provider Demographics
NPI:1295967495
Name:KISSEL, SAMUEL S (DDS)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:S
Last Name:KISSEL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 AVENUE OF THE AMERICAS
Mailing Address - Street 2:SUITE 2708
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-4702
Mailing Address - Country:US
Mailing Address - Phone:212-751-3710
Mailing Address - Fax:718-445-5474
Practice Address - Street 1:1350 AVENUE OF THE AMERICAS
Practice Address - Street 2:SUITE 2708
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-4702
Practice Address - Country:US
Practice Address - Phone:212-751-3710
Practice Address - Fax:718-445-5474
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-20
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22822122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist