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General NPI Number Information
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NPI Number | 1912818626
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Entity Type | Individual
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Provider Name | CASSIDY JEAN DARRAGH
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Gender |
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Dates
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Enumeration Date | 09/14/2026
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Last Update Date | 09/14/2026
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Provider Practice Location Address
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Address Line | 815 N CLARE AVE
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City | HARRISON
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State | MI
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Zip | 48625-8176
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Country | US
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Telephone | 989-630-0760
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Fax |
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Provider Business Mailing Address
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Address Line | 22211 BEECH ST
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City | DEARBORN
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State | MI
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Zip | 48124-2703
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Country | US
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Telephone | 313-590-6989
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 2901603302
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License Number State | MI
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