Provider Demographics
NPI:1497243422
Name:KATHLEEN M CASACCI DDS PC
Entity Type:Organization
Organization Name:KATHLEEN M CASACCI DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:CASACCI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:716-639-1271
Mailing Address - Street 1:3349 NIAGARA FALLS BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14120-1213
Mailing Address - Country:US
Mailing Address - Phone:716-694-1777
Mailing Address - Fax:716-694-1888
Practice Address - Street 1:3349 NIAGARA FALLS BLVD
Practice Address - Street 2:
Practice Address - City:NORTH TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14120-1213
Practice Address - Country:US
Practice Address - Phone:716-694-1777
Practice Address - Fax:716-694-1888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-25
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044773-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty