Basic Information
| Provider Information | |||||||||
| NPI: | 1306519657 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PIERRE-JEROME | ||||||||
| FirstName: | CASSANDRA | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10350 E KINETIC DR | ||||||||
| Address2: | |||||||||
| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852128129 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6194081003 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2875 W RAY RD STE 16 | ||||||||
| Address2: | |||||||||
| City: | CHANDLER | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852243619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4807921543 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/30/2021 | ||||||||
| LastUpdateDate: | 07/30/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | D011153 | AZ | Y | Dental Providers | Dentist | General Practice |
No ID Information.