Provider Demographics
NPI:1164835245
Name:STARR, CASSIE (DMD)
Entity Type:Individual
Prefix:
First Name:CASSIE
Middle Name:
Last Name:STARR
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4167 OHIO ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92104-1926
Mailing Address - Country:US
Mailing Address - Phone:619-281-6635
Mailing Address - Fax:
Practice Address - Street 1:4167 OHIO ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92104-1926
Practice Address - Country:US
Practice Address - Phone:619-281-6635
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-06
Last Update Date:2023-02-09
Deactivation Date:2018-09-26
Deactivation Code:
Reactivation Date:2018-10-03
Provider Licenses
StateLicense IDTaxonomies
CA103774122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist