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General NPI Number Information
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NPI Number | 1336307784
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Entity Type | Organization
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Legal Business Name | KENT A. CASERTA, DDS., INC.
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Dates
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Enumeration Date | 06/01/2008
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Last Update Date | 06/01/2008
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Provider Practice Location Address
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Address Line | 38530 LAKE SHORE BLVD
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City | WILLOUGHBY
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State | OH
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Zip | 44094-7163
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Country | US
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Telephone | 440-953-1733
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Fax | 440-946-1650
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Provider Business Mailing Address
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Address Line | 38530 LAKE SHORE BLVD
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City | WILLOUGHBY
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State | OH
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Zip | 44094-7163
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Country | US
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Telephone | 440-953-1733
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Fax | 440-946-1650
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KENT ANGELO CASERTA
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Credential | DDS
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Telephone | 440-953-1733
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 3001527
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License Number State | OH
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