Provider Demographics
NPI:1932581246
Name:MATTHEW I KESSMAN DDS PC
Entity type:Organization
Organization Name:MATTHEW I KESSMAN DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:B
Authorized Official - Last Name:KESSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:718-335-4980
Mailing Address - Street 1:8604 GRAND AVE STE L2
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-8803
Mailing Address - Country:US
Mailing Address - Phone:718-335-4980
Mailing Address - Fax:718-565-1245
Practice Address - Street 1:8604 GRAND AVE STE L2
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-8803
Practice Address - Country:US
Practice Address - Phone:718-335-4980
Practice Address - Fax:718-565-1245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-23
Last Update Date:2015-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY23620122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty