Provider Demographics
NPI:1043279136
Name:CASEY, TODD M (DDS)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:M
Last Name:CASEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2915 HUNTER MILL RD
Mailing Address - Street 2:#20
Mailing Address - City:OAKTON
Mailing Address - State:VA
Mailing Address - Zip Code:22124-1716
Mailing Address - Country:US
Mailing Address - Phone:703-938-7773
Mailing Address - Fax:703-938-7780
Practice Address - Street 1:2915 HUNTER MILL RD
Practice Address - Street 2:#20
Practice Address - City:OAKTON
Practice Address - State:VA
Practice Address - Zip Code:22124-1716
Practice Address - Country:US
Practice Address - Phone:703-938-7773
Practice Address - Fax:703-938-7780
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010086081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice