Provider Demographics
NPI:1336414283
Name:KASOUHA, AMIR (DMD)
Entity type:Individual
Prefix:DR
First Name:AMIR
Middle Name:
Last Name:KASOUHA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5210 TAYLOR POND LN
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01730-4412
Mailing Address - Country:US
Mailing Address - Phone:617-294-9285
Mailing Address - Fax:
Practice Address - Street 1:5210 TAYLOR POND LN
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:01730-4412
Practice Address - Country:US
Practice Address - Phone:617-294-9285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-11
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX277631223G0001X
MADN18561701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice