Provider Demographics
NPI:1356058366
Name:WARREN, CASSI MICHELLE (RDH)
Entity type:Individual
Prefix:MRS
First Name:CASSI
Middle Name:MICHELLE
Last Name:WARREN
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:MISS
Other - First Name:CASSI
Other - Middle Name:MICHELLE
Other - Last Name:MCCRACKEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:43402 CALLAWAY CT UNIT A
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260-9411
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:78640 HIGHWAY 111
Practice Address - Street 2:
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253-2048
Practice Address - Country:US
Practice Address - Phone:760-564-0955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-31
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARDH27453124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist