Provider Demographics
NPI:1629363940
Name:DORSEY, CASSANDRA L (DMD)
Entity Type:Individual
Prefix:DR
First Name:CASSANDRA
Middle Name:L
Last Name:DORSEY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6709 COLONNADE AVE
Mailing Address - Street 2:
Mailing Address - City:VIERA
Mailing Address - State:FL
Mailing Address - Zip Code:32940-6118
Mailing Address - Country:US
Mailing Address - Phone:321-433-1022
Mailing Address - Fax:321-433-1032
Practice Address - Street 1:6709 COLONNADE AVE
Practice Address - Street 2:
Practice Address - City:VIERA
Practice Address - State:FL
Practice Address - Zip Code:32940-6118
Practice Address - Country:US
Practice Address - Phone:321-433-1022
Practice Address - Fax:321-433-1032
Is Sole Proprietor?:No
Enumeration Date:2011-06-15
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN19359122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist