Individual
SERENA KASSAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
345 E 24TH ST # 9W, NEW YORK, NY 10010-4020
(617) 699-8465
Mailing address
200 HIGH SERVICE AVE, 4TH FL. MARION HALL, NORTH PROVIDENCE, RI 02904-5113
(401) 456-3309
(401) 456-3762
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
056467
NY
1223P0221X
Pediatric Dentistry
LD00017
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
056467
NYS DENTAL LICENSE
NY
01
—
LD00017
LIMITED LICENSE
RI
Enumeration date
06/06/2007
Last updated
12/02/2019
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