Provider Demographics
NPI:1184240236
Name:MESSER, CASEY NAN (DDS)
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:NAN
Last Name:MESSER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:716 OCONTO PL
Mailing Address - Street 2:
Mailing Address - City:DE PERE
Mailing Address - State:WI
Mailing Address - Zip Code:54115-3669
Mailing Address - Country:US
Mailing Address - Phone:715-923-1106
Mailing Address - Fax:
Practice Address - Street 1:2805 LIBAL ST STE B
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-2888
Practice Address - Country:US
Practice Address - Phone:920-339-9013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-24
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1002329-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist