Provider Demographics
NPI:1275776189
Name:EDMUND A. CASSELLA DMD, LLC
Entity Type:Organization
Organization Name:EDMUND A. CASSELLA DMD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDMUND
Authorized Official - Middle Name:A
Authorized Official - Last Name:CASSELLA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:808-955-1506
Mailing Address - Street 1:1441 KAPIOLANI BLVD STE 1506
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-4407
Mailing Address - Country:US
Mailing Address - Phone:808-955-1506
Mailing Address - Fax:808-955-1551
Practice Address - Street 1:1441 KAPIOLANI BLVD STE 1506
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-4407
Practice Address - Country:US
Practice Address - Phone:808-955-1506
Practice Address - Fax:808-955-1551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-08
Last Update Date:2009-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI17481223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty