Provider Demographics
NPI:1629778485
Name:CASCO, SAMUEL (DDS)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
Last Name:CASCO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3302 GASTON AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-2013
Mailing Address - Country:US
Mailing Address - Phone:214-828-8215
Mailing Address - Fax:
Practice Address - Street 1:5701 PRESIDENT GEORGE BUSH HWY STE 140
Practice Address - Street 2:
Practice Address - City:ROWLETT
Practice Address - State:TX
Practice Address - Zip Code:75089-3694
Practice Address - Country:US
Practice Address - Phone:214-703-0703
Practice Address - Fax:214-703-0702
Is Sole Proprietor?:No
Enumeration Date:2023-03-08
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TX39793122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program