Provider Demographics
NPI:1720651698
Name:CASSERLY, MEGAN (DDS)
Entity Type:Individual
Prefix:MISS
First Name:MEGAN
Middle Name:
Last Name:CASSERLY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 STATE ST
Mailing Address - Street 2:
Mailing Address - City:FORT SCOTT
Mailing Address - State:KS
Mailing Address - Zip Code:66701-2031
Mailing Address - Country:US
Mailing Address - Phone:314-853-7340
Mailing Address - Fax:
Practice Address - Street 1:204 STATE ST
Practice Address - Street 2:
Practice Address - City:FORT SCOTT
Practice Address - State:KS
Practice Address - Zip Code:66701-2031
Practice Address - Country:US
Practice Address - Phone:314-853-7340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-20
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS61890122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist