Individual provider Active NPI

Andrew Lance Kassman, D.M.D.

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Tucson, AZ
National Provider Identifier
1740365592
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X
License
2495 Issued in AZ
Practice address
6700 N. Oracle Road
Suite 327
Tucson, AZ 85704-7740
Phone
(520) 575-1177
Fax
(520) 297-3328
NPI assigned
Oct 26, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthodontics and Dentofacial Orthopedics Dentistry 1223X0400X 2495 AZ Primary

Addresses

Primary practice location

6700 N. Oracle Road
Suite 327
Tucson, AZ 85704-7740

Mailing address

6700 N. Oracle Road
Suite 327
Tucson, AZ 85704-7740
Phone (520) 575-1177

Other identifiers 1

IdentifierTypeStateIssuer
601947OtherAZUNITED CONCORDIA-TRICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
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

Enrollment IDStateProvider typePAC IDDetails
I20211216001216 AZ Order and Referring Only - DentistPractitioner - Dentist 0446641930

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2495AZMDOrthodontics and Dentofacial Orthopedic Dentist

NPI Registry JSON

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

{
    "created_epoch": "1161820800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1740365592",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6700 N. ORACLE ROAD",
            "address_2": "SUITE 327",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857047740",
            "telephone_number": "520-575-1177",
            "fax_number": "520-297-3328"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6700 N. ORACLE ROAD",
            "address_2": "SUITE 327",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857047740",
            "telephone_number": "520-575-1177",
            "fax_number": "520-297-3328"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KASSMAN",
        "first_name": "ANDREW",
        "middle_name": "LANCE",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-26",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "AZ",
            "license": "2495",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA-TRICARE",
            "identifier": "601947",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tucson, AZ

Sources for this page

Verify at the official NPI Registry.