Provider Demographics
NPI:1558094813
Name:BUMMER, CASSIDY JEZLYN (DDS)
Entity Type:Individual
Prefix:DR
First Name:CASSIDY
Middle Name:JEZLYN
Last Name:BUMMER
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 1:107 H ST
Mailing Address - Street 2:
Mailing Address - City:POPLAR
Mailing Address - State:MT
Mailing Address - Zip Code:59255-7817
Mailing Address - Country:US
Mailing Address - Phone:406-768-3491
Mailing Address - Fax:406-768-3603
Practice Address - Street 1:107 H STREET E
Practice Address - Street 2:
Practice Address - City:POPLAR
Practice Address - State:MT
Practice Address - Zip Code:59255
Practice Address - Country:US
Practice Address - Phone:406-768-3491
Practice Address - Fax:406-768-3603
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-05
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTDEN-DEN-LIC-237051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice