Provider Demographics
NPI:1720490303
Name:CAO, CASSANDRA (DDS)
Entity type:Individual
Prefix:DR
First Name:CASSANDRA
Middle Name:
Last Name:CAO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 WATER ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BOYNE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49712-1810
Mailing Address - Country:US
Mailing Address - Phone:231-154-7763
Mailing Address - Fax:231-582-2967
Practice Address - Street 1:14435 NORTHLAND DR
Practice Address - Street 2:
Practice Address - City:BIG RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49307-2368
Practice Address - Country:US
Practice Address - Phone:231-796-3617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-29
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901021233122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist