Provider Demographics
NPI:1700593787
Name:JON W. CASSELL, D.D.S. INC.
Entity type:Organization
Organization Name:JON W. CASSELL, D.D.S. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JON
Authorized Official - Middle Name:W
Authorized Official - Last Name:CASSELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:619-987-2550
Mailing Address - Street 1:591 CAMINO DE LA REINA STE 412
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3106
Mailing Address - Country:US
Mailing Address - Phone:619-220-7475
Mailing Address - Fax:619-220-7484
Practice Address - Street 1:591 CAMINO DE LA REINA STE 412
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3106
Practice Address - Country:US
Practice Address - Phone:619-220-7475
Practice Address - Fax:619-220-7484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-31
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental