Provider Demographics
NPI:1114931433
Name:CASAUS, JENNIFER I (DDS, PA)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:I
Last Name:CASAUS
Suffix:
Gender:F
Credentials:DDS, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5920 CUBERO DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-3867
Mailing Address - Country:US
Mailing Address - Phone:505-822-0663
Mailing Address - Fax:505-797-0531
Practice Address - Street 1:5920 CUBERO DR NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-3867
Practice Address - Country:US
Practice Address - Phone:505-822-0663
Practice Address - Fax:505-797-0531
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM17681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice