Provider Demographics
NPI:1699308585
Name:AL KAISSEY, QUSSAY (DDS)
Entity type:Individual
Prefix:DR
First Name:QUSSAY
Middle Name:
Last Name:AL KAISSEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:QUSSAY
Other - Middle Name:
Other - Last Name:AL KAISSEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:236 JAMACHA RD STE 101
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92019-2366
Mailing Address - Country:US
Mailing Address - Phone:619-448-7444
Mailing Address - Fax:619-448-7147
Practice Address - Street 1:236 JAMACHA RD STE 101
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92019-2366
Practice Address - Country:US
Practice Address - Phone:619-448-7444
Practice Address - Fax:619-448-7444
Is Sole Proprietor?:No
Enumeration Date:2020-02-19
Last Update Date:2024-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA104806122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist