Provider Demographics
NPI:1417755620
Name:JANSEN, CASSANDRA L (DENTAL HYGIENIST)
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:L
Last Name:JANSEN
Suffix:
Gender:
Credentials:DENTAL HYGIENIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601B W. WASHNGTON ST.
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:NY
Mailing Address - Zip Code:14456-2119
Mailing Address - Country:US
Mailing Address - Phone:315-781-8448
Mailing Address - Fax:
Practice Address - Street 1:601B W. WASHNGTON ST.
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:NY
Practice Address - Zip Code:14456-2119
Practice Address - Country:US
Practice Address - Phone:315-781-8448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-04
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032398124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist