Provider Demographics
NPI:1811024011
Name:CASSITY, DANIEL KIM (DMD,MS)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:KIM
Last Name:CASSITY
Suffix:
Gender:M
Credentials:DMD,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5331 S ADAMS AVE
Mailing Address - Street 2:STE A
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84405-4753
Mailing Address - Country:US
Mailing Address - Phone:801-475-5577
Mailing Address - Fax:
Practice Address - Street 1:5331 S ADAMS AVE
Practice Address - Street 2:STE A
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84405-4753
Practice Address - Country:US
Practice Address - Phone:801-475-5577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4934211-99221223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics