Provider Demographics
NPI:1558036095
Name:DE WOLFE, CASSANDRA (RDH)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:
Last Name:DE WOLFE
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N2781 MALONEY RD
Mailing Address - Street 2:
Mailing Address - City:FREEDOM
Mailing Address - State:WI
Mailing Address - Zip Code:54130-8635
Mailing Address - Country:US
Mailing Address - Phone:262-844-1988
Mailing Address - Fax:
Practice Address - Street 1:N2781 MALONEY RD
Practice Address - Street 2:
Practice Address - City:FREEDOM
Practice Address - State:WI
Practice Address - Zip Code:54130-8635
Practice Address - Country:US
Practice Address - Phone:262-844-1988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-16
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI100280716124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist