Provider Demographics
NPI:1801449608
Name:CASSIS, VALERIE J (DMD)
Entity type:Individual
Prefix:DR
First Name:VALERIE
Middle Name:J
Last Name:CASSIS
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 1:2429 LOCUST ST APT 419
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-5559
Mailing Address - Country:US
Mailing Address - Phone:617-750-2767
Mailing Address - Fax:
Practice Address - Street 1:2429 LOCUST ST APT 419
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-5559
Practice Address - Country:US
Practice Address - Phone:617-750-2767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-20
Last Update Date:2019-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN1002012122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice