Healthcare Provider Details

I. General information

NPI: 1235128604
Provider Name (Legal Business Name): CASSANDRA KATHLEEN WRIGHT DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2005
Last Update Date: 03/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

238 BROOKLEY AVE
BOLLING AFB DC
20332-0001
US

IV. Provider business mailing address

9701 SHEET CT
CHELTENHAM MD
20623-1349
US

V. Phone/Fax

Practice location:
  • Phone: 202-404-5519
  • Fax:
Mailing address:
  • Phone: 301-372-3535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number0401410559
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: