Provider Demographics
NPI:1932720539
Name:CORNETT, CASSIDY ELIZABETH (DMD)
Entity Type:Individual
Prefix:DR
First Name:CASSIDY
Middle Name:ELIZABETH
Last Name:CORNETT
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:CMR 467 BOX 5588
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09096-0056
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:WIESBADEN DENTAL CLINIC
Practice Address - Street 2:FLUGPLATZ ERBENHEIM 1040
Practice Address - City:WIESBADEN
Practice Address - State:DE
Practice Address - Zip Code:65205
Practice Address - Country:DE
Practice Address - Phone:314-590-1515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-05
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
KY10432122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program