Provider Demographics
NPI:1467018077
Name:CASSIDY, BRENNAN PATRICK KEARNS (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRENNAN
Middle Name:PATRICK KEARNS
Last Name:CASSIDY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 ELLINGTON RD
Mailing Address - Street 2:
Mailing Address - City:LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01106-1559
Mailing Address - Country:US
Mailing Address - Phone:413-237-6392
Mailing Address - Fax:
Practice Address - Street 1:377 MONTGOMERY ST
Practice Address - Street 2:
Practice Address - City:CHICOPEE
Practice Address - State:MA
Practice Address - Zip Code:01020-1929
Practice Address - Country:US
Practice Address - Phone:413-592-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-20
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT128011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice