Provider Demographics
NPI:1790806693
Name:KEVIN M CASSIDY DDS, MS, PA
Entity Type:Organization
Organization Name:KEVIN M CASSIDY DDS, MS, PA
Other - Org Name:CASSIDY ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:CASSIDY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:785-233-0582
Mailing Address - Street 1:2301 SW 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66606-1759
Mailing Address - Country:US
Mailing Address - Phone:785-233-0582
Mailing Address - Fax:785-233-1251
Practice Address - Street 1:2301 SW 6TH AVE
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66606-1759
Practice Address - Country:US
Practice Address - Phone:785-233-0582
Practice Address - Fax:785-233-1251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS68641223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty