Healthcare Provider Details

I. General information

NPI: 1336233857
Provider Name (Legal Business Name): JAMES P CASSIDY DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7140 MIAMI AVE SUITE 202
CINCINNATI OH
45243
US

IV. Provider business mailing address

7140 MIAMI AVE SUITE 202
CINCINNATI OH
45243
US

V. Phone/Fax

Practice location:
  • Phone: 513-271-5900
  • Fax: 513-271-5911
Mailing address:
  • Phone: 513-271-5900
  • Fax: 513-271-5911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberOH30017898
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: