Provider Demographics
NPI:1841331287
Name:CASSITY, JESSICA LYNN (DDS)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYNN
Last Name:CASSITY
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 1:102 N KENWOOD ST
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-2724
Mailing Address - Country:US
Mailing Address - Phone:307-234-3100
Mailing Address - Fax:307-234-3104
Practice Address - Street 1:102 N KENWOOD ST
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-2724
Practice Address - Country:US
Practice Address - Phone:307-234-3100
Practice Address - Fax:307-234-3104
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY11131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice