Provider Demographics
NPI:1063580934
Name:MCCASKEY, WANDA (DDS)
Entity type:Individual
Prefix:
First Name:WANDA
Middle Name:
Last Name:MCCASKEY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 N WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:AR
Mailing Address - Zip Code:72601-4232
Mailing Address - Country:US
Mailing Address - Phone:870-204-6974
Mailing Address - Fax:
Practice Address - Street 1:112 N WILLOW ST
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-4232
Practice Address - Country:US
Practice Address - Phone:870-204-6974
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2009-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3540122300000X
MO015631122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist