Provider Demographics
NPI:1164642179
Name:CASAS, GILDA I (DDS)
Entity Type:Individual
Prefix:
First Name:GILDA
Middle Name:I
Last Name:CASAS
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 1:8211 ROUGHRIDER DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78239-2446
Mailing Address - Country:US
Mailing Address - Phone:210-392-5550
Mailing Address - Fax:
Practice Address - Street 1:8211 ROUGHRIDER DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78239-2446
Practice Address - Country:US
Practice Address - Phone:210-655-9497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20711122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1540007-01Medicaid