Healthcare Provider Details

I. General information

NPI: 1477985927
Provider Name (Legal Business Name): CASSANDRA LEE ZIRBEL DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CASSANDRA LEE KRETCHMER DDS

II. Dates (important events)

Enumeration Date: 08/07/2013
Last Update Date: 08/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7729 79TH ST S
COTTAGE GROVE MN
55016-1832
US

IV. Provider business mailing address

6012 MILITARY RD
WOODBURY MN
55129-9509
US

V. Phone/Fax

Practice location:
  • Phone: 651-459-6674
  • Fax:
Mailing address:
  • Phone: 651-983-2828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberD12892
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: