Provider Demographics
NPI:1972779064
Name:CASSANO, THERESA A (DMD)
Entity type:Individual
Prefix:DR
First Name:THERESA
Middle Name:A
Last Name:CASSANO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:168 MOUNTAIN AVE
Mailing Address - Street 2:
Mailing Address - City:HACKETTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07840-2324
Mailing Address - Country:US
Mailing Address - Phone:908-852-6611
Mailing Address - Fax:908-852-5636
Practice Address - Street 1:168 MOUNTAIN AVE
Practice Address - Street 2:
Practice Address - City:HACKETTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07840-2324
Practice Address - Country:US
Practice Address - Phone:908-852-6611
Practice Address - Fax:908-852-5636
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DIO2086200122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist