Healthcare Provider Details

I. General information

NPI: 1235246448
Provider Name (Legal Business Name): JACK H CASALE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 12/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27727 N 68TH PL
SCOTTSDALE AZ
85266-7534
US

IV. Provider business mailing address

27727 N 68TH PL
SCOTTSDALE AZ
85266-7534
US

V. Phone/Fax

Practice location:
  • Phone: 516-729-1604
  • Fax:
Mailing address:
  • Phone: 516-729-1604
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberD008110
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: