Healthcare Provider Details

I. General information

NPI: 1922076348
Provider Name (Legal Business Name): GREGORY M CASEY DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 02/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3388 WOODS EDGE CR STE #103
BONITA SPRINGS FL
34134
US

IV. Provider business mailing address

3388 WOODS EDGE CR STE #103
BONITA SPRINGS FL
34134
US

V. Phone/Fax

Practice location:
  • Phone: 239-947-6637
  • Fax: 239-947-3223
Mailing address:
  • Phone: 239-947-6637
  • Fax: 239-947-6631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDN17367
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: