Provider Demographics
NPI:1780782136
Name:CASSALIA, BENJAMIN A (DMD)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:A
Last Name:CASSALIA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 MEADOWBROOK LN
Mailing Address - Street 2:
Mailing Address - City:CHALFONT
Mailing Address - State:PA
Mailing Address - Zip Code:18914-2811
Mailing Address - Country:US
Mailing Address - Phone:215-822-6320
Mailing Address - Fax:215-822-6520
Practice Address - Street 1:308 N MAIN ST STE B-100
Practice Address - Street 2:
Practice Address - City:CHALFONT
Practice Address - State:PA
Practice Address - Zip Code:18914-2705
Practice Address - Country:US
Practice Address - Phone:215-822-6320
Practice Address - Fax:215-822-6520
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS 028221L1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics