Provider Demographics
NPI:1578608444
Name:CASASNOVAS, MANUEL ENRIQUE (DMD)
Entity Type:Individual
Prefix:DR
First Name:MANUEL
Middle Name:ENRIQUE
Last Name:CASASNOVAS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5908
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-5908
Mailing Address - Country:US
Mailing Address - Phone:787-744-5900
Mailing Address - Fax:787-966-8692
Practice Address - Street 1:COND DEGETAU # A-2
Practice Address - Street 2:URB. BONNEVILLE TERRACE
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00727-2363
Practice Address - Country:US
Practice Address - Phone:787-744-5900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1578608444OtherNPI