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General NPI Number Information
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NPI Number | 1114078862
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Entity Type | Individual
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Provider Name | MARK WORTHINGTON CASEY DDS, MPH
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Gender | Male
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Dates
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Enumeration Date | 01/16/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1985 UMSTEAD DR 2501 MAIL SERVICE CENTER
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City | RALEIGH
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State | NC
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Zip | 27699-2501
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Country | US
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Telephone | 919-855-4280
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Fax | 919-715-2738
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Provider Business Mailing Address
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Address Line | 9805 TANDEM CT
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City | RALEIGH
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State | NC
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Zip | 27615-1553
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Country | US
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Telephone | 919-844-2969
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Fax | 919-676-2588
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223D0001X
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Taxonomy Name | Public Health Dentistry
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License Number | 7913
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License Number State | NC
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