Healthcare Provider Details

I. General information

NPI: 1902383961
Provider Name (Legal Business Name): CASSANDRA JEAN RAMCHARAN DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS CASSANDRA JEAN HANKS

II. Dates (important events)

Enumeration Date: 07/23/2018
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 W MAIN ST
KELSO WA
98626-1117
US

IV. Provider business mailing address

409 W MAIN ST
KELSO WA
98626-1117
US

V. Phone/Fax

Practice location:
  • Phone: 360-577-1153
  • Fax:
Mailing address:
  • Phone: 360-577-1153
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDENT.DE.70147642
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberD10864
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: