Provider Demographics
NPI:1215034004
Name:CASACCI, KATHLEEN MARIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:MARIE
Last Name:CASACCI
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 1:3349 NIAGARA FALLS BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14120-1213
Mailing Address - Country:US
Mailing Address - Phone:716-694-1777
Mailing Address - Fax:716-694-1888
Practice Address - Street 1:3571 NIAGARA FALLS BLVD
Practice Address - Street 2:
Practice Address - City:NORTH TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14120-1200
Practice Address - Country:US
Practice Address - Phone:716-694-1777
Practice Address - Fax:716-694-1888
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044773-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice