MEDICARE: DR. THERESA A CASSANO DMD

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	122300000X	Dentist	22DIO2086200	NJ

General Provider Information

NPI Number	:	1972779064
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THERESA A CASSANO DMD

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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/07/2008
Last Update Date	:	05/07/2008

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