Provider Demographics
NPI:1417192725
Name:CASEY DENTAL INSTITUTE P.C.
Entity Type:Organization
Organization Name:CASEY DENTAL INSTITUTE P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAWN MICHAEL
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:CASEY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:570-654-4141
Mailing Address - Street 1:1120 OAK ST
Mailing Address - Street 2:
Mailing Address - City:PITTSTON TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:18640-3770
Mailing Address - Country:US
Mailing Address - Phone:570-654-4141
Mailing Address - Fax:570-654-2150
Practice Address - Street 1:1120 OAK ST
Practice Address - Street 2:
Practice Address - City:PITTSTON TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:18640-3770
Practice Address - Country:US
Practice Address - Phone:570-654-4141
Practice Address - Fax:570-654-2150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-16
Last Update Date:2008-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS028971L1223G0001X
PADS0353981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty