Provider Demographics
NPI:1619004868
Name:CASSIDY, MARK JOSEPH (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:JOSEPH
Last Name:CASSIDY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
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Mailing Address - Street 1:6979 S HOLLY CIR
Mailing Address - Street 2:#280
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-1577
Mailing Address - Country:US
Mailing Address - Phone:303-779-1977
Mailing Address - Fax:303-779-2530
Practice Address - Street 1:6979 S HOLLY CIR
Practice Address - Street 2:#280
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-1577
Practice Address - Country:US
Practice Address - Phone:303-779-1977
Practice Address - Fax:303-779-2530
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1057661223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics