Provider Demographics
NPI:1568401677
Name:CASSAT, D. DOUGLAS (DDS)
Entity Type:Individual
Prefix:DR
First Name:D.
Middle Name:DOUGLAS
Last Name:CASSAT
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 1:10789 TIERRASANTA BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92124-2613
Mailing Address - Country:US
Mailing Address - Phone:858-565-0212
Mailing Address - Fax:858-541-7029
Practice Address - Street 1:10789 TIERRASANTA BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92124-2613
Practice Address - Country:US
Practice Address - Phone:858-565-0212
Practice Address - Fax:858-541-7029
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA249511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice