MEDICARE: DR. THERESA ANNE CASPER-KLOCK DDS

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	1223G0001X	General Practice Dentistry	043090	NY

General Provider Information

NPI Number	:	1013911502
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THERESA ANNE CASPER-KLOCK DDS

Provider Business Mailing Address
First Line	:	33 WILLIAM ST
Second Line	:	STE 1
City	:	AUBURN
State	:	NY
Zip	:	13021-3730
Country	:	US
Telephone Number	:	315-253-8891
Fax Number	:

Provider Business Practice Location Address
First Line	:	33 WILLIAM ST
Second Line	:	STE 1
City	:	AUBURN
State	:	NY
Zip	:	13021-3730
Country	:	US
Telephone Number	:	315-253-8891
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	07/08/2007

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Directions to “ DR. THERESA ANNE CASPER-KLOCK DDS” Practice Location

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