MEDICARE: DR. M SANDRA CASPER 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	3749015	WI

General Provider Information

NPI Number	:	1679681761
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. M SANDRA CASPER DDS

Provider Business Mailing Address
First Line	:	6878 N SANTA MONICA BLVD
Second Line	:
City	:	FOX POINT
State	:	WI
Zip	:	53217
Country	:	US
Telephone Number	:	414-247-1990
Fax Number	:	414-247-1995

Provider Business Practice Location Address
First Line	:	6878 N SANTA MONICA BLVD
Second Line	:
City	:	FOX POINT
State	:	WI
Zip	:	53217
Country	:	US
Telephone Number	:	414-247-1990
Fax Number	:	414-247-1995

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

Provider Enumeration Date	:	08/28/2006
Last Update Date	:	07/08/2007

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