MEDICARE: CASEY ORAL & FACIAL SURGICAL ARTS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)		FL

General Provider Information

NPI Number	:	1013174937
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CASEY ORAL & FACIAL SURGICAL ARTS LLC

Provider Business Mailing Address
First Line	:	3388 WOODS EDGE CIR
Second Line	:	UNIT 103
City	:	BONITA SPRINGS
State	:	FL
Zip	:	34134-1368
Country	:	US
Telephone Number	:	239-947-6637
Fax Number	:	239-947-3223

Provider Business Practice Location Address
First Line	:	3388 WOODS EDGE CIR
Second Line	:	UNIT 103
City	:	BONITA SPRINGS
State	:	FL
Zip	:	34134-1368
Country	:	US
Telephone Number	:	239-947-6637
Fax Number	:	239-947-3223

Authorized Official
Title or Position	:	OWNER
Name	:	DR. GREGORY M CASEY
Credential	:	DDS, PA
Telephone Number	:	239-947-6637

Provider Enumeration Date	:	05/19/2008
Last Update Date	:	07/21/2022

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