Provider Demographics
NPI:1336434919
Name:TESSARO, CASANDRA LEE (DMD)
Entity type:Individual
Prefix:DR
First Name:CASANDRA
Middle Name:LEE
Last Name:TESSARO
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 1:3131 WALNUT ST
Mailing Address - Street 2:205
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-3415
Mailing Address - Country:US
Mailing Address - Phone:216-217-0256
Mailing Address - Fax:
Practice Address - Street 1:3131 WALNUT ST
Practice Address - Street 2:205
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-3415
Practice Address - Country:US
Practice Address - Phone:216-217-0256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-13
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0385711223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics