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Organization
BRUCE L. CASSIS
Active
Organization
BRUCE L. CASSIS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRUCE L CASSIS DDS (OWNER)
(304) 574-0424
Entity
Organization
Contact information
Practice address
138 LIVELY ST, FAYETTEVILLE, WV 25840-1148
(304) 574-0424
(304) 574-2102
Mailing address
138 LIVELY ST, P. O. BOX 926, FAYETTEVILLE, WV 25840-1148
(304) 574-0424
(304) 574-2102
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3810007224
—
WV
Enumeration date
01/03/2008
Last updated
01/03/2008
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