Provider Demographics
NPI:1184005241
Name:DENTAL FACULTY PRACTICE ASSOC INC - PAUL S. CASAMASSIMO DDS
Entity type:Organization
Organization Name:DENTAL FACULTY PRACTICE ASSOC INC - PAUL S. CASAMASSIMO DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-292-1472
Mailing Address - Street 1:305 W 12TH AVE
Mailing Address - Street 2:POSTLE HALL ROOM 4015
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43210-1267
Mailing Address - Country:US
Mailing Address - Phone:614-292-1472
Mailing Address - Fax:614-688-3553
Practice Address - Street 1:305 W 12TH AVE
Practice Address - Street 2:POSTLE HALL ROOM 4015
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210-1267
Practice Address - Country:US
Practice Address - Phone:614-292-1472
Practice Address - Fax:614-688-3553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-15
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH71.0002441223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty