Provider Demographics
NPI:1861412876
Name:KESSEL, A EDWARD JR (DDS)
Entity type:Individual
Prefix:DR
First Name:A
Middle Name:EDWARD
Last Name:KESSEL
Suffix:JR
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 1:664 MAHONING ST
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:PA
Mailing Address - Zip Code:17847-2240
Mailing Address - Country:US
Mailing Address - Phone:570-742-8231
Mailing Address - Fax:570-742-4980
Practice Address - Street 1:664 MAHONING ST
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:PA
Practice Address - Zip Code:17847-2240
Practice Address - Country:US
Practice Address - Phone:570-742-8231
Practice Address - Fax:570-742-4980
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0206371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA735573OtherUNITED CONCORDIA