Provider Demographics
NPI:1194964866
Name:ZIAD KASSAB D.D.S INC
Entity type:Organization
Organization Name:ZIAD KASSAB D.D.S INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ZIAD
Authorized Official - Middle Name:
Authorized Official - Last Name:KASSAB
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-305-6900
Mailing Address - Street 1:1437 W ARROW HWY
Mailing Address - Street 2:
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-2331
Mailing Address - Country:US
Mailing Address - Phone:909-305-6900
Mailing Address - Fax:909-305-6990
Practice Address - Street 1:1437 W ARROW HWY
Practice Address - Street 2:
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-2331
Practice Address - Country:US
Practice Address - Phone:909-305-6900
Practice Address - Fax:909-305-6990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-19
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49556305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========Medicaid