Provider Demographics
NPI:1285853408
Name:IVERSTINE, CASEY LYNN (DDS)
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:LYNN
Last Name:IVERSTINE
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 1:4837 HIGHWAY 568
Mailing Address - Street 2:
Mailing Address - City:FERRIDAY
Mailing Address - State:LA
Mailing Address - Zip Code:71334-4431
Mailing Address - Country:US
Mailing Address - Phone:318-757-3786
Mailing Address - Fax:
Practice Address - Street 1:207 SERIO BLVD
Practice Address - Street 2:
Practice Address - City:FERRIDAY
Practice Address - State:LA
Practice Address - Zip Code:71334-2014
Practice Address - Country:US
Practice Address - Phone:318-757-4561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5802122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist