Healthcare Provider Details

I. General information

NPI: 1699800649
Provider Name (Legal Business Name): ALEX G. CASSINELLI, D.M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 07/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7242 TYLERS CORNER DR
WEST CHESTER OH
45069-6334
US

IV. Provider business mailing address

7242 TYLERS CORNER DR
WEST CHESTER OH
45069-6334
US

V. Phone/Fax

Practice location:
  • Phone: 513-777-7060
  • Fax: 513-777-0716
Mailing address:
  • Phone: 513-777-7060
  • Fax: 513-777-0716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number20241
License Number StateOH

VIII. Authorized Official

Name: DR. ALEXANDER GERARD CASSINELLI
Title or Position: PRESIDENT
Credential: D.M.D., M.S.
Phone: 513-777-7060