Healthcare Provider Details

I. General information

NPI: 1831929868
Provider Name (Legal Business Name): CASSIDY HINE DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2024
Last Update Date: 08/05/2024
Certification Date: 08/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1381 UNIVERSITY ST
HEALDSBURG CA
95448-3314
US

IV. Provider business mailing address

5859 LEONA CT
WINDSOR CA
95492-8627
US

V. Phone/Fax

Practice location:
  • Phone: 707-433-5494
  • Fax:
Mailing address:
  • Phone: 801-721-6027
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number13996067-9926
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: