Provider Demographics
NPI:1366455065
Name:SPITZLEY, CASSANDRA J (DDS)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:J
Last Name:SPITZLEY
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 1:14213 GOLF COURSE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BAXTER
Mailing Address - State:MN
Mailing Address - Zip Code:56425
Mailing Address - Country:US
Mailing Address - Phone:218-829-4511
Mailing Address - Fax:218-829-5483
Practice Address - Street 1:14213 GOLF COURSE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:BAXTER
Practice Address - State:MN
Practice Address - Zip Code:56425
Practice Address - Country:US
Practice Address - Phone:218-829-4511
Practice Address - Fax:218-829-5483
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND109771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice