MEDICARE: GREGORY M CASEY 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	390200000X	Student in an Organized Health Care Education/Training Program		FL
2	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	DN17367	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922076348
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREGORY M CASEY DDS

Provider Business Mailing Address
First Line	:	3388 WOODS EDGE CR
Second Line	:	STE #103
City	:	BONITA SPRINGS
State	:	FL
Zip	:	34134
Country	:	US
Telephone Number	:	239-947-6637
Fax Number	:	239-947-6631

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

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

Provider Enumeration Date	:	03/10/2006
Last Update Date	:	05/28/2026

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Directions to “ GREGORY M CASEY DDS” Practice Location

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