Provider Demographics
NPI:1811226848
Name:CASAGRANDE, MICHAEL STEPHEN (DDS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:STEPHEN
Last Name:CASAGRANDE
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 1:1111 24TH ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-5019
Mailing Address - Country:US
Mailing Address - Phone:916-441-0655
Mailing Address - Fax:916-441-6665
Practice Address - Street 1:1111 24TH ST
Practice Address - Street 2:SUITE 203
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5019
Practice Address - Country:US
Practice Address - Phone:916-441-0655
Practice Address - Fax:916-441-6665
Is Sole Proprietor?:No
Enumeration Date:2009-12-22
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA498531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice