Provider Demographics
NPI:1124629829
Name:KASISA, MEENA A (DMD)
Entity type:Individual
Prefix:
First Name:MEENA
Middle Name:A
Last Name:KASISA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19778 E CARRIAGE WAY
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-8670
Mailing Address - Country:US
Mailing Address - Phone:480-227-1055
Mailing Address - Fax:
Practice Address - Street 1:41620 W MARICOPA CASA GRANDE HWY STE 110
Practice Address - Street 2:
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85138-3217
Practice Address - Country:US
Practice Address - Phone:520-568-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-08
Last Update Date:2020-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD010885122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist