Provider Demographics
NPI:1003263377
Name:KASSEN, ALLISON MARIE JOHNSON (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALLISON
Middle Name:MARIE JOHNSON
Last Name:KASSEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MS
Other - First Name:ALLISON
Other - Middle Name:MARIE
Other - Last Name:MCMILLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1000 RADIO DR STE 240
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-8444
Mailing Address - Country:US
Mailing Address - Phone:651-343-9776
Mailing Address - Fax:
Practice Address - Street 1:1000 RADIO DR STE 240
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-8444
Practice Address - Country:US
Practice Address - Phone:651-739-1894
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-17
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND13660122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist