Provider Demographics
NPI:1083738918
Name:JOHN C CASON DDS PA
Entity Type:Organization
Organization Name:JOHN C CASON DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:CARROLL
Authorized Official - Last Name:CASON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:505-434-0470
Mailing Address - Street 1:1211 NEW YORK AVE
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-6727
Mailing Address - Country:US
Mailing Address - Phone:505-434-0470
Mailing Address - Fax:505-439-5905
Practice Address - Street 1:1211 NEW YORK AVE
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-6727
Practice Address - Country:US
Practice Address - Phone:505-434-0470
Practice Address - Fax:505-439-5905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM12271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM00083212Medicare ID - Type UnspecifiedNM MEDICAID PROVIDER NUMB