MEDICARE: JEFFREY M. CASIGLIA DMD DMSC PC

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
1	1223G0001X	General Practice Dentistry	19726	MA

General Provider Information

NPI Number	:	1790952638
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JEFFREY M. CASIGLIA DMD DMSC PC

Provider Business Mailing Address
First Line	:	398 ESSEX ST
Second Line	:
City	:	SALEM
State	:	MA
Zip	:	01970-3154
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	398 ESSEX ST
Second Line	:
City	:	SALEM
State	:	MA
Zip	:	01970-3154
Country	:	US
Telephone Number	:	978-744-7904
Fax Number	:

Authorized Official
Title or Position	:	OWNER/MASTER
Name	:	DR. JEFFREY MICHAEL CASIGLIA
Credential	:	DMD DMSC
Telephone Number	:	978-744-7904

Provider Enumeration Date	:	05/09/2008
Last Update Date	:	05/09/2008

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