Provider Demographics
NPI:1407326523
Name:CASAS, ADELA (RDH)
Entity Type:Individual
Prefix:
First Name:ADELA
Middle Name:
Last Name:CASAS
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:ADELA
Other - Middle Name:
Other - Last Name:DIAZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:1100 SW SAINT LUCIE WEST BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-1780
Mailing Address - Country:US
Mailing Address - Phone:772-807-1451
Mailing Address - Fax:
Practice Address - Street 1:1100 SW SAINT LUCIE WEST BLVD
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-1780
Practice Address - Country:US
Practice Address - Phone:772-807-1451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-01
Last Update Date:2018-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
18382124Q00000X
FL18382124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist