Provider Demographics
NPI:1013174937
Name:CASEY ORAL & FACIAL SURGICAL ARTS LLC
Entity Type:Organization
Organization Name:CASEY ORAL & FACIAL SURGICAL ARTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:M
Authorized Official - Last Name:CASEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, PA
Authorized Official - Phone:239-947-6637
Mailing Address - Street 1:3388 WOODS EDGE CIR
Mailing Address - Street 2:UNIT 103
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34134-1368
Mailing Address - Country:US
Mailing Address - Phone:239-947-6637
Mailing Address - Fax:239-947-3223
Practice Address - Street 1:3388 WOODS EDGE CIR
Practice Address - Street 2:UNIT 103
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34134-1368
Practice Address - Country:US
Practice Address - Phone:239-947-6637
Practice Address - Fax:239-947-3223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty