Healthcare Provider Details

I. General information

NPI: 1710808233
Provider Name (Legal Business Name): KASSIDY WOLFE, DMD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 S GREEN RIVER RD
EVANSVILLE IN
47715-7314
US

IV. Provider business mailing address

11700 DIAMOND ISLAND RD
WADESVILLE IN
47638-9108
US

V. Phone/Fax

Practice location:
  • Phone: 812-476-3131
  • Fax:
Mailing address:
  • Phone: 812-575-7204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. KASSIDY SUGGS
Title or Position: MEMBER
Credential: DMD
Phone: 812-575-7204