Provider Demographics
NPI:1750300562
Name:CASELLA, SHAWN D (DMD)
Entity Type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:D
Last Name:CASELLA
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 1:333 STATE ST
Mailing Address - Street 2:SUITE 310
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16507-1450
Mailing Address - Country:US
Mailing Address - Phone:814-456-0710
Mailing Address - Fax:814-459-2783
Practice Address - Street 1:333 STATE ST
Practice Address - Street 2:SUITE 310
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16507-1450
Practice Address - Country:US
Practice Address - Phone:814-456-0710
Practice Address - Fax:814-459-2783
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-026927-L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice