Provider Demographics
NPI:1275612962
Name:THERESA A. CASSANO, D.M.D., PC
Entity Type:Organization
Organization Name:THERESA A. CASSANO, D.M.D., PC
Other - Org Name:HACKETTSTOWN FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:A
Authorized Official - Last Name:CASSANO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:908-852-6611
Mailing Address - Street 1:168 MOUNTAIN AVE
Mailing Address - Street 2:
Mailing Address - City:HACKETTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07840-2324
Mailing Address - Country:US
Mailing Address - Phone:908-852-6611
Mailing Address - Fax:908-852-5636
Practice Address - Street 1:168 MOUNTAIN AVE
Practice Address - Street 2:
Practice Address - City:HACKETTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07840-2324
Practice Address - Country:US
Practice Address - Phone:908-852-6611
Practice Address - Fax:908-852-5636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI020862001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty