Provider Demographics
NPI:1568569473
Name:CASIGLIA, JEFFREY M (DMD, DMSC)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:M
Last Name:CASIGLIA
Suffix:
Gender:M
Credentials:DMD, DMSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:398 ESSEX ST
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-3154
Mailing Address - Country:US
Mailing Address - Phone:978-744-7904
Mailing Address - Fax:978-745-8302
Practice Address - Street 1:398 ESSEX ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-3154
Practice Address - Country:US
Practice Address - Phone:978-744-7904
Practice Address - Fax:978-745-8302
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA197261223G0001X, 261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental