Provider Demographics
NPI:1407417462
Name:MCCARTHY, CASSI (DMD)
Entity Type:Individual
Prefix:DR
First Name:CASSI
Middle Name:
Last Name:MCCARTHY
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 1:3017 SAINT MARYS AVE APT 407
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68105-2765
Mailing Address - Country:US
Mailing Address - Phone:262-716-7570
Mailing Address - Fax:
Practice Address - Street 1:5321 CENTER ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68106-2338
Practice Address - Country:US
Practice Address - Phone:402-551-2238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-20
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE7559122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty