Provider Demographics
NPI:1508198276
Name:CASSELL, ROBERT WILFRED (DDS)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:WILFRED
Last Name:CASSELL
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 1:351 W. SWANSON AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654
Mailing Address - Country:US
Mailing Address - Phone:907-376-5315
Mailing Address - Fax:907-376-7855
Practice Address - Street 1:351 W. SWANSON AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654
Practice Address - Country:US
Practice Address - Phone:907-376-5315
Practice Address - Fax:907-376-7855
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-05
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK7061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice