Provider Demographics
NPI:1679026108
Name:DAVIS, CASSANDRA
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BLDG 1040 WHEATHON AVE
Mailing Address - Street 2:
Mailing Address - City:WIESBADEN
Mailing Address - State:HESSEN
Mailing Address - Zip Code:65205
Mailing Address - Country:DE
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:BLDG 1040 WHEATHON AVE
Practice Address - Street 2:
Practice Address - City:WIESBADEN
Practice Address - State:HESSEN
Practice Address - Zip Code:65205
Practice Address - Country:DE
Practice Address - Phone:314-590-1515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-02
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist