Provider Demographics
NPI:1083741573
Name:CASSITY, DAVID E (DMD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:E
Last Name:CASSITY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:KY
Mailing Address - Zip Code:42025-1123
Mailing Address - Country:US
Mailing Address - Phone:270-527-8484
Mailing Address - Fax:270-527-2204
Practice Address - Street 1:117 W 5TH ST
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:KY
Practice Address - Zip Code:42025-1123
Practice Address - Country:US
Practice Address - Phone:270-527-8484
Practice Address - Fax:270-527-2204
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY55761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice