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NPI Code Detail

MEDICARE: DR. MARK WORTHINGTON CASEY DDS, MPH

MEDICARE:  DR. MARK WORTHINGTON CASEY  DDS, MPH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223D0001XPublic Health Dentistry7913NC

General Provider Information

NPI Number : 1114078862
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARK WORTHINGTON CASEY DDS, MPH
Provider Business Mailing Address
First Line : 9805 TANDEM CT
Second Line :
City : RALEIGH
State : NC
Zip : 27615-1553
Country : US
Telephone Number : 919-844-2969
Fax Number : 919-676-2588
Provider Business Practice Location Address
First Line : 1985 UMSTEAD DR
Second Line : 2501 MAIL SERVICE CENTER
City : RALEIGH
State : NC
Zip : 27699-2501
Country : US
Telephone Number : 919-855-4280
Fax Number : 919-715-2738
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/16/2007
Last Update Date : 07/08/2007

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