MEDICARE: DR. JOSE C CASELLAS D.M.D., M.S.

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	1223P0300X	Periodontics	2023	PR

General Provider Information

NPI Number	:	1588700215
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSE C CASELLAS D.M.D., M.S.

Provider Business Mailing Address
First Line	:	18 AVE WALL
Second Line	:	TERRS DE TINTILLO
City	:	GUAYNABO
State	:	PR
Zip	:	00966-1657
Country	:	US
Telephone Number	:	787-707-1779
Fax Number	:

Provider Business Practice Location Address
First Line	:	519 AVE MIRAMAR
Second Line	:
City	:	ARECIBO
State	:	PR
Zip	:	00612-4360
Country	:	US
Telephone Number	:	787-817-5652
Fax Number	:	787-817-5633

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

Provider Enumeration Date	:	01/29/2007
Last Update Date	:	07/08/2007

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