NPIMap

Organization Active NPI

Bruce L. Cassis

  • General Practice Dentistry
  • Fayetteville, WV
National Provider Identifier
1275718710
Registry record updated Jan 3, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
BRUCE L. CASSIS
Practice address
138 Lively St
Fayetteville, WV 25840-1148
Phone
(304) 574-0424
Fax
(304) 574-2102
NPI assigned
Jan 3, 2008
Last updated
Jan 3, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 3, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Bruce L Cassis, DDSNPI 1679664510
Title
Owner
Phone
(304) 574-0424

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X NU Primary

Addresses

Primary practice location

138 Lively St
Fayetteville, WV 25840-1148

Mailing address

138 Lively St
P. O. Box 926
Fayetteville, WV 25840-1148
Phone (304) 574-0424

Other identifiers 1

IdentifierTypeStateIssuer
3810007224MedicaidWV

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1199318400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1199318400000",
    "number": "1275718710",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "138 LIVELY ST",
            "address_2": "P. O. BOX 926",
            "city": "FAYETTEVILLE",
            "state": "WV",
            "postal_code": "258401148",
            "telephone_number": "304-574-0424",
            "fax_number": "304-574-2102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "138 LIVELY ST",
            "city": "FAYETTEVILLE",
            "state": "WV",
            "postal_code": "258401148",
            "telephone_number": "304-574-0424",
            "fax_number": "304-574-2102"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRUCE L. CASSIS",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-03",
        "last_updated": "2008-01-03",
        "status": "A",
        "authorized_official_last_name": "CASSIS",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "304-574-0424",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810007224",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.