Provider Demographics
NPI:1154458271
Name:CASELLAS, JORGE CLEMENTE (DDS)
Entity Type:Individual
Prefix:DR
First Name:JORGE
Middle Name:CLEMENTE
Last Name:CASELLAS
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 1:2890 SAND RUN PKWY
Mailing Address - Street 2:
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44333-2875
Mailing Address - Country:US
Mailing Address - Phone:330-836-0135
Mailing Address - Fax:330-836-3818
Practice Address - Street 1:2890 SAND RUN PKWY
Practice Address - Street 2:
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-2875
Practice Address - Country:US
Practice Address - Phone:330-836-0135
Practice Address - Fax:330-836-3818
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-0221451223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics