Provider Demographics
NPI:1730254871
Name:CASSEDAY, BRYAN S (DDS)
Entity type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:S
Last Name:CASSEDAY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1815 61ST AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634
Mailing Address - Country:US
Mailing Address - Phone:970-351-6200
Mailing Address - Fax:970-351-0027
Practice Address - Street 1:1815 61ST AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634
Practice Address - Country:US
Practice Address - Phone:970-351-6200
Practice Address - Fax:970-351-0027
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7468122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist