MEDICARE: THERESA A. CASSANO, D.M.D., PC

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	22DI02086200	NJ

General Provider Information

NPI Number	:	1275612962
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THERESA A. CASSANO, D.M.D., PC

Provider Business Mailing Address
First Line	:	168 MOUNTAIN AVE
Second Line	:
City	:	HACKETTSTOWN
State	:	NJ
Zip	:	07840-2324
Country	:	US
Telephone Number	:	908-852-6611
Fax Number	:	908-852-5636

Provider Business Practice Location Address
First Line	:	168 MOUNTAIN AVE
Second Line	:
City	:	HACKETTSTOWN
State	:	NJ
Zip	:	07840-2324
Country	:	US
Telephone Number	:	908-852-6611
Fax Number	:	908-852-5636

Authorized Official
Title or Position	:	PRESIDENT
Name	:	THERESA A. CASSANO
Credential	:	D.M.D.
Telephone Number	:	908-852-6611

Provider Enumeration Date	:	11/03/2006
Last Update Date	:	08/22/2020

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