Basic Information
Provider Information
NPI: 1417340431
EntityType: 2
ReplacementNPI:  
OrganizationName: DR EDWARD A KAHN PLLC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 3189
Address2:  
City: SYRACUSE
State: NY
PostalCode: 132203189
CountryCode: US
TelephoneNumber: 3154546000
FaxNumber:  
Practice Location
Address1: 1683 24TH AVE NW
Address2:  
City: NORMAN
State: OK
PostalCode: 730696566
CountryCode: US
TelephoneNumber: 4052532253
FaxNumber:  
Other Information
ProviderEnumerationDate: 03/16/2015
LastUpdateDate: 03/16/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: KAHN
AuthorizedOfficialFirstName: EDWARD
AuthorizedOfficialMiddleName: A
AuthorizedOfficialTitleorPosition: OWNER
AuthorizedOfficialTelephone: 4052532253
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: DDS
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1223G0001X5691OKY193400000X SINGLE SPECIALTY GROUPDental ProvidersDentistGeneral Practice

No ID Information.


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