MEDICARE: CASSANDRA WIECKHORST DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	2901022592	MI
2	1223G0001X	General Practice Dentistry	D011244	AZ

General Provider Information

NPI Number	:	1508358664
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASSANDRA WIECKHORST DDS

Provider Business Mailing Address
First Line	:	2700 BAKER ST
Second Line	:
City	:	MUSKEGON
State	:	MI
Zip	:	49444-2157
Country	:	US
Telephone Number	:	231-737-1335
Fax Number	:	231-737-0534

Provider Business Practice Location Address
First Line	:	2700 BAKER ST
Second Line	:
City	:	MUSKEGON
State	:	MI
Zip	:	49444-2157
Country	:	US
Telephone Number	:	231-737-1335
Fax Number	:	231-737-0534

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/05/2018
Last Update Date	:	02/11/2026

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