Provider Demographics
NPI:1235246448
Name:CASALE, JACK H (DDS)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:H
Last Name:CASALE
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 1:27727 N 68TH PL
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85266-7534
Mailing Address - Country:US
Mailing Address - Phone:516-729-1604
Mailing Address - Fax:
Practice Address - Street 1:27727 N 68TH PL
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85266-7534
Practice Address - Country:US
Practice Address - Phone:516-729-1604
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0081101223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics