Provider Demographics
NPI:1518065069
Name:CASEY, DIANE ELIZABETH (DDS)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:ELIZABETH
Last Name:CASEY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3681 CALICO AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-2538
Mailing Address - Country:US
Mailing Address - Phone:408-559-3570
Mailing Address - Fax:
Practice Address - Street 1:877 W FREMONT AVE STE D3
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087-2319
Practice Address - Country:US
Practice Address - Phone:408-736-3882
Practice Address - Fax:408-736-3883
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADY 367351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice