Provider Demographics
NPI:1538767520
Name:KNOWLES, CASSANDRA ELIZABETH
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:ELIZABETH
Last Name:KNOWLES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3626 POPLAR RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23061-3267
Mailing Address - Country:US
Mailing Address - Phone:609-433-2558
Mailing Address - Fax:
Practice Address - Street 1:3626 POPLAR RIDGE DR
Practice Address - Street 2:
Practice Address - City:GLOUCESTER
Practice Address - State:VA
Practice Address - Zip Code:23061-3267
Practice Address - Country:US
Practice Address - Phone:609-433-2558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-13
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24769124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist