Provider Demographics
NPI:1629069125
Name:BURNETT, CASSANDRA DARICE (DDS)
Entity Type:Individual
Prefix:DR
First Name:CASSANDRA
Middle Name:DARICE
Last Name:BURNETT
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 1:1318 N CAROLINE ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21213-2820
Mailing Address - Country:US
Mailing Address - Phone:410-685-8753
Mailing Address - Fax:410-685-1343
Practice Address - Street 1:1318 N CAROLINE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21213-2820
Practice Address - Country:US
Practice Address - Phone:410-685-8753
Practice Address - Fax:410-685-1343
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD130431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice