Provider Demographics
NPI:1457468530
Name:WENCE, CASSIE (DMD)
Entity Type:Individual
Prefix:
First Name:CASSIE
Middle Name:
Last Name:WENCE
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 1:11708 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40243-1426
Mailing Address - Country:US
Mailing Address - Phone:502-245-8627
Mailing Address - Fax:502-245-9395
Practice Address - Street 1:911 PALATKA RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40214-3461
Practice Address - Country:US
Practice Address - Phone:502-366-2448
Practice Address - Fax:502-366-3551
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY80151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice