Provider Demographics
NPI:1114047867
Name:CASSAIDY, JULIE DIANE (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:DIANE
Last Name:CASSAIDY
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3200 KINGMAN RD
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50014-3941
Mailing Address - Country:US
Mailing Address - Phone:515-292-5762
Mailing Address - Fax:
Practice Address - Street 1:707 5TH ST
Practice Address - Street 2:SUITE 102
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-5979
Practice Address - Country:US
Practice Address - Phone:515-232-2152
Practice Address - Fax:515-232-2153
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA77681223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics