Provider Demographics
NPI:1306636253
Name:ANTAR, KASSEM (DDS)
Entity type:Individual
Prefix:
First Name:KASSEM
Middle Name:
Last Name:ANTAR
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 1:5530 COVINGTON CT APT 110
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-2666
Mailing Address - Country:US
Mailing Address - Phone:424-522-3741
Mailing Address - Fax:
Practice Address - Street 1:4700 SCHAEFER RD STE 190
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-3759
Practice Address - Country:US
Practice Address - Phone:313-945-8900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-12
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIPENDING122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist