Provider Demographics
NPI:1609919372
Name:PIETROK, CASSANDRA JEAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:CASSANDRA
Middle Name:JEAN
Last Name:PIETROK
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 1:12021 SHAMROCK PLZ
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-3533
Mailing Address - Country:US
Mailing Address - Phone:402-330-2243
Mailing Address - Fax:402-330-0408
Practice Address - Street 1:12021 SHAMROCK PLZ
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-3533
Practice Address - Country:US
Practice Address - Phone:402-330-2243
Practice Address - Fax:402-330-0408
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE60003122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist