Provider Demographics
NPI:1215995436
Name:CASERTA, JAMES (DDS)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:
Last Name:CASERTA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1009 REDDING RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-1934
Mailing Address - Country:US
Mailing Address - Phone:203-259-6999
Mailing Address - Fax:
Practice Address - Street 1:633 CLINTON AVE
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06605-1711
Practice Address - Country:US
Practice Address - Phone:203-384-2261
Practice Address - Fax:203-366-4094
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0038611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice