Provider Demographics
NPI:1700495272
Name:DEPAUW, CASEY
Entity Type:Individual
Prefix:DR
First Name:CASEY
Middle Name:
Last Name:DEPAUW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 RICHFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14220-1914
Mailing Address - Country:US
Mailing Address - Phone:315-573-6355
Mailing Address - Fax:
Practice Address - Street 1:1066 ABBOTT RD # 1
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14220-2756
Practice Address - Country:US
Practice Address - Phone:716-828-2295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-30
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY061128122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist