Provider Demographics
NPI:1376998450
Name:MARC C CASSELLA DMD
Entity Type:Organization
Organization Name:MARC C CASSELLA DMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:C
Authorized Official - Last Name:CASSELLA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:412-673-4338
Mailing Address - Street 1:3017 VERSAILLES AVE
Mailing Address - Street 2:
Mailing Address - City:MCKEESPORT
Mailing Address - State:PA
Mailing Address - Zip Code:15132-1921
Mailing Address - Country:US
Mailing Address - Phone:412-673-4338
Mailing Address - Fax:412-673-3761
Practice Address - Street 1:3017 VERSAILLES AVE
Practice Address - Street 2:
Practice Address - City:MCKEESPORT
Practice Address - State:PA
Practice Address - Zip Code:15132-1921
Practice Address - Country:US
Practice Address - Phone:412-673-4338
Practice Address - Fax:412-673-3761
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-26
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS025173L261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010628770001Medicaid