Provider Demographics
NPI:1619959046
Name:CASSELLA, MARC CHRISTOPHER (DMD)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:CHRISTOPHER
Last Name:CASSELLA
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 1:3017 VERSAILLES AVE
Mailing Address - Street 2:
Mailing Address - City:MCKEESPORT
Mailing Address - State:PA
Mailing Address - Zip Code:15132-1921
Mailing Address - Country:US
Mailing Address - Phone:412-673-4338
Mailing Address - Fax:412-673-3761
Practice Address - Street 1:3017 VERSAILLES AVE
Practice Address - Street 2:
Practice Address - City:MCKEESPORT
Practice Address - State:PA
Practice Address - Zip Code:15132-1921
Practice Address - Country:US
Practice Address - Phone:412-673-4338
Practice Address - Fax:412-673-3761
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS025173L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1062877Medicaid