Provider Demographics
NPI:1922076348
Name:CASEY, GREGORY M (DDS)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:M
Last Name:CASEY
Suffix:
Gender:M
Credentials:DDS
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Mailing Address - Street 1:3388 WOODS EDGE CR
Mailing Address - Street 2:STE #103
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34134
Mailing Address - Country:US
Mailing Address - Phone:239-947-6637
Mailing Address - Fax:239-947-6631
Practice Address - Street 1:3388 WOODS EDGE CR
Practice Address - Street 2:STE #103
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34134
Practice Address - Country:US
Practice Address - Phone:239-947-6637
Practice Address - Fax:239-947-3223
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-10
Last Update Date:2017-02-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLDN173671223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL076081100Medicaid
V07323Medicare UPIN
FL076081100Medicaid