Provider Demographics
NPI:1164596235
Name:CASACLANG, CYNTHIA BALDOVINO (DDS)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:BALDOVINO
Last Name:CASACLANG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:495 N RIVERSIDE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031
Mailing Address - Country:US
Mailing Address - Phone:847-336-8611
Mailing Address - Fax:847-336-8199
Practice Address - Street 1:495 N RIVERSIDE
Practice Address - Street 2:SUITE 204
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031
Practice Address - Country:US
Practice Address - Phone:847-336-8611
Practice Address - Fax:847-336-8199
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice