Provider Demographics
NPI:1427122621
Name:KASSAR, RAEDA (DDS)
Entity type:Individual
Prefix:DR
First Name:RAEDA
Middle Name:
Last Name:KASSAR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MRS
Other - First Name:RAEDA
Other - Middle Name:ELIAS
Other - Last Name:ADIB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4735 VALLEY CENTER AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-3530
Mailing Address - Country:US
Mailing Address - Phone:626-967-9889
Mailing Address - Fax:
Practice Address - Street 1:220 S GLENDORA AVE
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91741-3441
Practice Address - Country:US
Practice Address - Phone:626-914-4054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA500291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice