Provider Demographics
NPI:1952019044
Name:MACASAET, CLARISSE (DMD)
Entity Type:Individual
Prefix:
First Name:CLARISSE
Middle Name:
Last Name:MACASAET
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8457 ELK GROVE FLORIN RD STE 130
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-9564
Mailing Address - Country:US
Mailing Address - Phone:916-681-8899
Mailing Address - Fax:
Practice Address - Street 1:8457 ELK GROVE FLORIN RD STE 130
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95624-9564
Practice Address - Country:US
Practice Address - Phone:916-681-8899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-08
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1082531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice