Provider Demographics
NPI:1487657391
Name:CASANOVA, FRANK (DDS, MSCD)
Entity Type:Individual
Prefix:DR
First Name:FRANK
Middle Name:
Last Name:CASANOVA
Suffix:
Gender:M
Credentials:DDS, MSCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 WATERMAN BLVD
Mailing Address - Street 2:STE 290
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94534-2972
Mailing Address - Country:US
Mailing Address - Phone:707-425-5666
Mailing Address - Fax:707-425-7046
Practice Address - Street 1:2801 WATERMAN BLVD
Practice Address - Street 2:STE 290
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94534-2972
Practice Address - Country:US
Practice Address - Phone:707-425-5666
Practice Address - Fax:707-425-7046
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA237141223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics