Provider Demographics
NPI:1548213911
Name:CASCADE FAMILY DENTISTRY PC
Entity Type:Organization
Organization Name:CASCADE FAMILY DENTISTRY PC
Other - Org Name:ESMILES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSANNE
Authorized Official - Middle Name:SCIGLIANO
Authorized Official - Last Name:EGGLESTON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:616-682-0147
Mailing Address - Street 1:6883 CASCADE RD SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-6899
Mailing Address - Country:US
Mailing Address - Phone:616-682-0147
Mailing Address - Fax:
Practice Address - Street 1:6883 CASCADE RD SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-6899
Practice Address - Country:US
Practice Address - Phone:616-682-0147
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010158351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIJ800194OtherBLUE CROSS BLUE SHIELD