Provider Demographics
NPI:1962185090
Name:CASSANDRA WILLIAMSON RDHAP, INC.
Entity type:Organization
Organization Name:CASSANDRA WILLIAMSON RDHAP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CASSANDRA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:WILLIAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:RDHAP
Authorized Official - Phone:909-693-0621
Mailing Address - Street 1:1311 FERNWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-5910
Mailing Address - Country:US
Mailing Address - Phone:909-693-0621
Mailing Address - Fax:
Practice Address - Street 1:1311 FERNWOOD DR
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-5910
Practice Address - Country:US
Practice Address - Phone:909-693-0621
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-07
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty