Provider Demographics
NPI:1437598976
Name:MENNEN, CASSIDY ANN (DMD)
Entity Type:Individual
Prefix:DR
First Name:CASSIDY
Middle Name:ANN
Last Name:MENNEN
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 1:275 S ASPEN ST BLDG 600
Mailing Address - Street 2:
Mailing Address - City:BUCKLEY AFB
Mailing Address - State:CO
Mailing Address - Zip Code:80011-9562
Mailing Address - Country:US
Mailing Address - Phone:720-847-6543
Mailing Address - Fax:
Practice Address - Street 1:300 TWINING ST BLDG 760
Practice Address - Street 2:
Practice Address - City:MAXWELL AFB
Practice Address - State:AL
Practice Address - Zip Code:36112-6027
Practice Address - Country:US
Practice Address - Phone:334-953-5143
Practice Address - Fax:334-953-8607
Is Sole Proprietor?:No
Enumeration Date:2013-06-18
Last Update Date:2018-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0396771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice