Provider Demographics
NPI:1114059425
Name:CASANOVA & IMHOFF DMD PA
Entity Type:Organization
Organization Name:CASANOVA & IMHOFF DMD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:S
Authorized Official - Last Name:IMHOFF
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:813-989-2775
Mailing Address - Street 1:11508 N 56TH ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33617-2239
Mailing Address - Country:US
Mailing Address - Phone:813-989-2775
Mailing Address - Fax:813-985-5980
Practice Address - Street 1:11508 N 56TH ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33617-2239
Practice Address - Country:US
Practice Address - Phone:813-989-2775
Practice Address - Fax:813-985-5980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN117821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty