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General NPI Number Information
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NPI Number | 1184084824
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Entity Type | Organization
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Legal Business Name | DAVID E. CASSITY PLLC
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Dates
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Enumeration Date | 02/23/2016
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Last Update Date | 02/23/2016
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Provider Practice Location Address
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Address Line | 117 W 5TH ST
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City | BENTON
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State | KY
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Zip | 42025-1123
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Country | US
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Telephone | 270-527-8484
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Fax | 270-527-2204
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Provider Business Mailing Address
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Address Line | 117 W 5TH ST
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City | BENTON
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State | KY
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Zip | 42025-1123
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Country | US
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Telephone | 270-527-8484
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Fax | 270-527-2204
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Authorized Official
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Title or Position | REGISTERED AGENT/ ORGANIZER
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Name | DAVID E. CASSITY
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Credential | DMD
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Telephone | 270-527-8484
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 5576
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License Number State | KY
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