Provider Demographics
NPI:1770856007
Name:CASELDINE DENTAL, SURPRISE, PLLC
Entity Type:Organization
Organization Name:CASELDINE DENTAL, SURPRISE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:O
Authorized Official - Last Name:CASELDINE
Authorized Official - Suffix:
Authorized Official - Credentials:D,DS
Authorized Official - Phone:480-898-3053
Mailing Address - Street 1:633 N GILBERT RD
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85203-6629
Mailing Address - Country:US
Mailing Address - Phone:480-898-3053
Mailing Address - Fax:480-656-4864
Practice Address - Street 1:14239 W BELL RD
Practice Address - Street 2:SUITE 220
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-2469
Practice Address - Country:US
Practice Address - Phone:623-518-2686
Practice Address - Fax:623-518-2875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-16
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty