Provider Demographics
NPI:1700865516
Name:CASSIDY, KEVIN MICHAEL (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:MICHAEL
Last Name:CASSIDY
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:2301 SW 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66606-1759
Mailing Address - Country:US
Mailing Address - Phone:785-233-0582
Mailing Address - Fax:785-233-1251
Practice Address - Street 1:2301 SW 6TH AVE
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66606-1759
Practice Address - Country:US
Practice Address - Phone:785-233-0582
Practice Address - Fax:785-233-1251
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS68641223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics