Provider Demographics
NPI:1578122545
Name:VAN KLEUNEN, CASSANDRA ANN (DDS)
Entity Type:Individual
Prefix:DR
First Name:CASSANDRA
Middle Name:ANN
Last Name:VAN KLEUNEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:CASSANDRA
Other - Middle Name:ANN
Other - Last Name:HAINER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:6191 S. 108TH STREET
Mailing Address - Street 2:
Mailing Address - City:HALES CORNERS
Mailing Address - State:WI
Mailing Address - Zip Code:53130
Mailing Address - Country:US
Mailing Address - Phone:414-427-9090
Mailing Address - Fax:414-427-8390
Practice Address - Street 1:6191 S. 108TH STREET
Practice Address - Street 2:
Practice Address - City:HALES CORNERS
Practice Address - State:WI
Practice Address - Zip Code:53130
Practice Address - Country:US
Practice Address - Phone:414-427-9090
Practice Address - Fax:414-427-8390
Is Sole Proprietor?:No
Enumeration Date:2019-06-12
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI100210315122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist