Active NPI
Gerald H Kassoy, DDS, MS
- Pediatric Dentistry
- Reynoldsburg, OH
National Provider Identifier
1073564142
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 14900
- Practice address
- 1418 Brice Rd
Reynoldsburg, OH 43068-2397 - Phone
- (614) 575-2225
- Fax
- (614) 575-2252
- NPI assigned
- May 13, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | 14900 | OH | Primary |
Addresses
Primary practice location
1418 Brice Rd
Reynoldsburg, OH 43068-2397
Mailing address
377 S Roosevelt Ave
Bexley, OH 43209-1831
Phone (614) 235-9931
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0398627 | Medicaid | OH | |
| 310961704-026 | Other | OH | CARESOURCE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 14900 | OH | MD | Pediatric Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147478400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1073564142",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "377 S ROOSEVELT AVE",
"city": "BEXLEY",
"state": "OH",
"postal_code": "432091831",
"telephone_number": "614-235-9931",
"fax_number": "614-575-2252"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1418 BRICE RD",
"city": "REYNOLDSBURG",
"state": "OH",
"postal_code": "430682397",
"telephone_number": "614-575-2225",
"fax_number": "614-575-2252"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KASSOY",
"first_name": "GERALD",
"middle_name": "H",
"name_prefix": "Dr.",
"credential": "DDS, MS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-13",
"last_updated": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "OH",
"license": "14900",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0398627",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CARESOURCE",
"identifier": "310961704-026",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Reynoldsburg, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.