Provider Demographics
NPI:1437049244
Name:KASSHAMOUN, ALEXANDER (DDS)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:
Last Name:KASSHAMOUN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2534 W SQUARE LAKE RD
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48324-1761
Mailing Address - Country:US
Mailing Address - Phone:248-881-2658
Mailing Address - Fax:
Practice Address - Street 1:28550 SOUTHFIELD RD
Practice Address - Street 2:
Practice Address - City:LATHRUP VILLAGE
Practice Address - State:MI
Practice Address - Zip Code:48076-2719
Practice Address - Country:US
Practice Address - Phone:248-230-2672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-04
Last Update Date:2025-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29016027461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice