Provider Demographics
NPI:1750853446
Name:CASADO, JAIME J
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:J
Last Name:CASADO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12601 SW 13TH ST APT 211
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33027-6896
Mailing Address - Country:US
Mailing Address - Phone:774-249-3781
Mailing Address - Fax:
Practice Address - Street 1:12601 SW 13TH ST APT 211
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33027-6896
Practice Address - Country:US
Practice Address - Phone:774-249-3781
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-19
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN23838122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist