Provider Demographics
NPI:1760710834
Name:KRUPANSKY, CASSANDRA (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:CASSANDRA
Middle Name:
Last Name:KRUPANSKY
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2520 DOUGLAS BLVD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-3992
Mailing Address - Country:US
Mailing Address - Phone:916-296-0036
Mailing Address - Fax:
Practice Address - Street 1:2520 DOUGLAS BLVD
Practice Address - Street 2:SUITE 130
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3992
Practice Address - Country:US
Practice Address - Phone:916-296-0036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-30
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251151223P0221X
CA548921223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry