Provider Demographics
NPI:1629279419
Name:JACK CASALE D.D.S., P.C.
Entity Type:Organization
Organization Name:JACK CASALE D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:H
Authorized Official - Last Name:CASALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-822-5757
Mailing Address - Street 1:380 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:JERICHO
Mailing Address - State:NY
Mailing Address - Zip Code:11753-2115
Mailing Address - Country:US
Mailing Address - Phone:516-822-5757
Mailing Address - Fax:
Practice Address - Street 1:380 N BROADWAY
Practice Address - Street 2:
Practice Address - City:JERICHO
Practice Address - State:NY
Practice Address - Zip Code:11753-2115
Practice Address - Country:US
Practice Address - Phone:516-822-5757
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0471181223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty