Provider Demographics
NPI:1508274499
Name:ZELENAK, CASSANDRA MAE (DDS)
Entity Type:Individual
Prefix:DR
First Name:CASSANDRA
Middle Name:MAE
Last Name:ZELENAK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 PRICKETTS FORT ROAD
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554
Mailing Address - Country:US
Mailing Address - Phone:304-376-5728
Mailing Address - Fax:
Practice Address - Street 1:215 LOGAN ST
Practice Address - Street 2:SUITE 41
Practice Address - City:WILLIAMSON
Practice Address - State:WV
Practice Address - Zip Code:25661
Practice Address - Country:US
Practice Address - Phone:304-236-2366
Practice Address - Fax:304-899-2227
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-24
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV4119122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist