Healthcare Provider Details

I. General information

NPI: 1154453629
Provider Name (Legal Business Name): SUZANNE CASSATA D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 RIDGE RD W
ROCHESTER NY
14615-3030
US

IV. Provider business mailing address

1 RIDGE RD W
ROCHESTER NY
14615-3030
US

V. Phone/Fax

Practice location:
  • Phone: 585-254-1650
  • Fax: 585-254-1653
Mailing address:
  • Phone: 585-254-1650
  • Fax: 585-254-1653

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number041656
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: