Individual
DR. KASSONDRA ANN MICHNO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
1280 WESTERN BLVD UNIT 200, JACKSONVILLE, NC 28546-7658
(910) 388-0223
Mailing address
826 HOMESTEAD DR, DALLAS, PA 18612-7227
(570) 332-1911
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
12265
NC
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/08/2021
Last updated
06/11/2021
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