Mehreen Bilal Kassoo, DMD

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

16417 Issued in MD

Practice address

12165 Elm St
Princess Anne, MD 21853-1358

Phone

(410) 651-5151

Fax

(410) 651-4256

NPI assigned

Feb 17, 2016

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MD

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Three Lower Counties Community Services, Inc.

  • Federally Qualified Health Center (FQHC)
  • Salisbury, MD
  • NPI 1275405714
  NPD (past)
• Three Lower Counties Community Services, Inc.

  • Federally Qualified Health Center (FQHC)
  • Salisbury, MD
  • NPI 1386157832
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1455667200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713744000000",
    "number": "1255790424",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1978",
            "city": "SALISBURY",
            "state": "MD",
            "postal_code": "218021978",
            "telephone_number": "410-749-1015",
            "fax_number": "410-749-0654"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12165 ELM ST",
            "city": "PRINCESS ANNE",
            "state": "MD",
            "postal_code": "218531358",
            "telephone_number": "410-651-5151",
            "fax_number": "410-651-4256"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "808 S 5th Ave",
            "address_purpose": "LOCATION",
            "city": "Denton",
            "state": "MD",
            "postal_code": "216291398",
            "country_code": "US",
            "telephone_number": "410-479-2650",
            "fax_number": "833-908-2283",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KASSOO",
        "first_name": "MEHREEN",
        "middle_name": "BILAL",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-02-17",
        "last_updated": "2024-04-22",
        "certification_date": "2024-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "MD",
            "license": "LL783",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "MD",
            "license": "16417",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Latoya Shenelle Johnson
• Lowa Gwen Johnson, LCPC
• Trent Johnson, DMD
• Edith Igere Jones
• Aya Kamoona
• Sukhvir Kaur, DDS
• Sydney Olivia Keating, LMSW
• Samantha Jean Kenney, LCSW-C
• Joayne Marie Kerry-Turner, CRNP
• Kevin King

• Pediatric Dentistry in Princess Anne, MD
• Providers in Princess Anne, MD by specialty
• Pediatric Dentistry in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.