Provider Demographics
NPI:1003023383
Name:CASPER, JOHN MARSHALL (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MARSHALL
Last Name:CASPER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:JOHN
Other - Middle Name:M
Other - Last Name:CASPER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:PO BOX 489
Mailing Address - Street 2:205 N MAIN ST
Mailing Address - City:ANNA
Mailing Address - State:IL
Mailing Address - Zip Code:62906-0489
Mailing Address - Country:US
Mailing Address - Phone:618-833-2314
Mailing Address - Fax:
Practice Address - Street 1:205 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ANNA
Practice Address - State:IL
Practice Address - Zip Code:62906-0489
Practice Address - Country:US
Practice Address - Phone:618-833-2314
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019158001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice