Provider Demographics
NPI:1194326900
Name:FICKEN, KASSIDEE N (RDH)
Entity type:Individual
Prefix:
First Name:KASSIDEE
Middle Name:N
Last Name:FICKEN
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7525 COUNTY ROAD M
Mailing Address - Street 2:
Mailing Address - City:KIRK
Mailing Address - State:CO
Mailing Address - Zip Code:80824-9759
Mailing Address - Country:US
Mailing Address - Phone:970-630-4226
Mailing Address - Fax:
Practice Address - Street 1:6671 HIGHWAY 36
Practice Address - Street 2:
Practice Address - City:JOES
Practice Address - State:CO
Practice Address - Zip Code:80822
Practice Address - Country:US
Practice Address - Phone:970-630-4226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-06
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO906449124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist