Provider Demographics
NPI:1518307453
Name:ALLISON, CASSIE L (DDS)
Entity Type:Individual
Prefix:
First Name:CASSIE
Middle Name:L
Last Name:ALLISON
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 1:4201 BROWN TRL STE 104
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-3941
Mailing Address - Country:US
Mailing Address - Phone:817-281-8633
Mailing Address - Fax:
Practice Address - Street 1:4201 BROWN TRL STE 104
Practice Address - Street 2:
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-3941
Practice Address - Country:US
Practice Address - Phone:817-281-8633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-25
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX292211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice