Provider Demographics
NPI:1659523538
Name:MCQUINN, KASSEY (DDS)
Entity Type:Individual
Prefix:DR
First Name:KASSEY
Middle Name:
Last Name:MCQUINN
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 1:3604 S STATE ROAD 19
Mailing Address - Street 2:
Mailing Address - City:TIPTON
Mailing Address - State:IN
Mailing Address - Zip Code:46072-9098
Mailing Address - Country:US
Mailing Address - Phone:765-675-2375
Mailing Address - Fax:
Practice Address - Street 1:650 FAIRGROUNDS RD
Practice Address - Street 2:
Practice Address - City:TIPTON
Practice Address - State:IN
Practice Address - Zip Code:46072-8599
Practice Address - Country:US
Practice Address - Phone:765-675-7595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-22
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08876541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice