Provider Demographics
NPI:1205632312
Name:WREDE, CASSIE JO (RDHAP)
Entity type:Individual
Prefix:MS
First Name:CASSIE
Middle Name:JO
Last Name:WREDE
Suffix:
Gender:
Credentials:RDHAP
Other - Prefix:
Other - First Name:CASSIE
Other - Middle Name:J
Other - Last Name:WREDE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2568 W RANCH ST
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92010-5634
Mailing Address - Country:US
Mailing Address - Phone:858-648-2221
Mailing Address - Fax:
Practice Address - Street 1:2568 W RANCH ST
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92010-5634
Practice Address - Country:US
Practice Address - Phone:858-648-2221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-20
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1136124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist