Provider Demographics
NPI:1942345665
Name:CASSADY, CHAD WILLIAM (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:WILLIAM
Last Name:CASSADY
Suffix:
Gender:M
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 1:4 BLACK TAIL LN
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-6306
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:26365 CARMEL RANCHO BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:CARMEL
Practice Address - State:CA
Practice Address - Zip Code:93923-8744
Practice Address - Country:US
Practice Address - Phone:831-624-7244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA487891223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics