Provider Demographics
NPI:1336370477
Name:FEDE, CASSIE ISABELLE (DMD)
Entity Type:Individual
Prefix:DR
First Name:CASSIE
Middle Name:ISABELLE
Last Name:FEDE
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 1:6800 MONTGOMERY BLVD NE STE F
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-1425
Mailing Address - Country:US
Mailing Address - Phone:505-883-8830
Mailing Address - Fax:
Practice Address - Street 1:6800 MONTGOMERY BLVD NE STE F
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-1425
Practice Address - Country:US
Practice Address - Phone:505-883-8830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-06
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD31851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice