Provider Demographics
NPI:1629183553
Name:CASEZZA, DONNA MARIA (DMD)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:MARIA
Last Name:CASEZZA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1535 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02724
Mailing Address - Country:US
Mailing Address - Phone:508-235-0499
Mailing Address - Fax:508-235-0497
Practice Address - Street 1:1535 S MAIN ST
Practice Address - Street 2:A
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02724
Practice Address - Country:US
Practice Address - Phone:508-235-0499
Practice Address - Fax:508-235-0497
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA15156122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist