Provider Demographics
NPI:1083725808
Name:CASADA, DARRELL BENTON (DMD)
Entity Type:Individual
Prefix:DR
First Name:DARRELL
Middle Name:BENTON
Last Name:CASADA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4122 SHELBYVILLE RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-3242
Mailing Address - Country:US
Mailing Address - Phone:502-896-4104
Mailing Address - Fax:502-896-4023
Practice Address - Street 1:4122 SHELBYVILLE RD
Practice Address - Street 2:SUITE 105
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-3242
Practice Address - Country:US
Practice Address - Phone:502-896-4104
Practice Address - Fax:502-896-4023
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY51561223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics