Provider Demographics
NPI:1316508104
Name:ALBERT, CASSANDRA KAY (DMD)
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:KAY
Last Name:ALBERT
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:357 CARL ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:IL
Mailing Address - Zip Code:62236-1909
Mailing Address - Country:US
Mailing Address - Phone:618-698-6900
Mailing Address - Fax:
Practice Address - Street 1:21 N DELAPLAINE RD
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:IL
Practice Address - Zip Code:60546-2022
Practice Address - Country:US
Practice Address - Phone:708-447-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-24
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0321631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice