=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245285568
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HERBERT THOMAS CASALENA D.D.S.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/24/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2300 PENNSYLVANIA AVE 6TH FLOOR, SUITE A&B
-----------------------------------------------------
City | WILMINGTON
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19806-1392
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-984-3300
-----------------------------------------------------
Fax | 302-984-3303
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2300 PENNSYLVANIA AVE 6TH FLOOR, SUITE A&B
-----------------------------------------------------
City | WILMINGTON
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19806-1392
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-984-3300
-----------------------------------------------------
Fax | 302-984-3303
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | G1-0000678
-----------------------------------------------------
License Number State | DE
-----------------------------------------------------