Provider Demographics
NPI:1922396977
Name:RICHARD, CASSANDRA TAVARES (DMD)
Entity Type:Individual
Prefix:DR
First Name:CASSANDRA
Middle Name:TAVARES
Last Name:RICHARD
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 HIGHLAND AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-2702
Mailing Address - Country:US
Mailing Address - Phone:978-740-5135
Mailing Address - Fax:
Practice Address - Street 1:100 HIGHLAND AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-2702
Practice Address - Country:US
Practice Address - Phone:978-740-5135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-12
Last Update Date:2015-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1855665122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist