Provider Demographics
NPI:1922414168
Name:MCKENZIE, CASSANDRA COLLINS (MA, DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:CASSANDRA
Middle Name:COLLINS
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:MA, DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13316 METCALF AVE
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66213-2804
Mailing Address - Country:US
Mailing Address - Phone:913-851-5110
Mailing Address - Fax:
Practice Address - Street 1:13316 METCALF AVE
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66213-2804
Practice Address - Country:US
Practice Address - Phone:913-851-5110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20140216851223P0300X
KS613121223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS61312OtherPERIODONTICS - KANSAS DENTAL BOARD
MO2014021685OtherDENTAL SPECIALIST - MISSOURI DENTAL BOARD
KSFM7146106OtherDEA
MO2014021685OtherDENTAL SPECIALIST - MISSOURI DENTAL BOARD