Provider Demographics
NPI:1346596376
Name:JESSICA L. CASSITY D.D.S.
Entity Type:Organization
Organization Name:JESSICA L. CASSITY D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:CASSITY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:307-234-3100
Mailing Address - Street 1:535 S CENTER ST
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-3130
Mailing Address - Country:US
Mailing Address - Phone:307-234-3100
Mailing Address - Fax:307-234-3104
Practice Address - Street 1:535 S CENTER ST
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-3130
Practice Address - Country:US
Practice Address - Phone:307-234-3100
Practice Address - Fax:307-234-3104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-27
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY1113122300000X
WY1318122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty