Provider Demographics
NPI:1215065990
Name:CASSIDY, PATRICK N (DMD)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:N
Last Name:CASSIDY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 PARKRISE CT
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519-7590
Mailing Address - Country:US
Mailing Address - Phone:919-387-1667
Mailing Address - Fax:
Practice Address - Street 1:103 PARKRISE CT
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27519-7590
Practice Address - Country:US
Practice Address - Phone:919-387-1667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC58991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice