Provider Demographics
NPI:1003487711
Name:SOPHER, KASSIE RAE (DDS)
Entity Type:Individual
Prefix:
First Name:KASSIE
Middle Name:RAE
Last Name:SOPHER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1170 TUTTLE ST UNIT 106
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-4314
Mailing Address - Country:US
Mailing Address - Phone:515-710-7983
Mailing Address - Fax:
Practice Address - Street 1:1345 E UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50316-2461
Practice Address - Country:US
Practice Address - Phone:515-264-9022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-03
Last Update Date:2021-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADDS-09925122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist