Provider Demographics
NPI:1699058305
Name:CASO, JONATHAN DAVID (DMD)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:DAVID
Last Name:CASO
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 1:9275 DOERR RD STE 1400
Mailing Address - Street 2:NORTHERN REGIONAL DENTAL COMMAND
Mailing Address - City:FORT BELVOIR
Mailing Address - State:VA
Mailing Address - Zip Code:22060-2204
Mailing Address - Country:US
Mailing Address - Phone:571-231-5374
Mailing Address - Fax:
Practice Address - Street 1:9275 DOERR RD STE 1400
Practice Address - Street 2:NORTHERN REGIONAL DENTAL COMMAND
Practice Address - City:FORT BELVOIR
Practice Address - State:VA
Practice Address - Zip Code:22060-2204
Practice Address - Country:US
Practice Address - Phone:571-231-5374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-20
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS038080122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist