Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | DIO2322700 | NJ |
NPI | 1013036052 |
---|---|
Provider Name | Dr. Kevin James Hassell |
First Address | Freehold, NJ 07728-4883 |
Second Address | Toms River, NJ 08753-2710 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2007 |
Last Update Date | 08/07/2007 |