Provider Demographics
NPI:1265441497
Name:ANTONIO D. CASO, D.D.S., P.S.
Entity Type:Organization
Organization Name:ANTONIO D. CASO, D.D.S., P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:
Authorized Official - Last Name:CASO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:509-529-3760
Mailing Address - Street 1:310 S 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-3037
Mailing Address - Country:US
Mailing Address - Phone:509-529-3760
Mailing Address - Fax:509-529-7622
Practice Address - Street 1:310 S 3RD AVE
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-3037
Practice Address - Country:US
Practice Address - Phone:509-529-3760
Practice Address - Fax:509-529-7622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000087391223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5046677Medicaid
8850511Medicare ID - Type Unspecified
WAV03041Medicare UPIN