Healthcare Provider Details

I. General information

NPI: 1154565851
Provider Name (Legal Business Name): DANA M CASAUS DDS, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2009
Last Update Date: 06/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5910 CUBERO DR NE SUITE D
ALBUQUERQUE NM
87109-3842
US

IV. Provider business mailing address

5910 CUBERO DR NE SUITE D
ALBUQUERQUE NM
87109-3842
US

V. Phone/Fax

Practice location:
  • Phone: 505-508-4939
  • Fax: 505-717-1218
Mailing address:
  • Phone: 505-508-4939
  • Fax: 505-717-1218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDD3113
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: