Provider Demographics
NPI:1992893515
Name:CASASNOVAS, MARISEL (DMD)
Entity type:Individual
Prefix:DR
First Name:MARISEL
Middle Name:
Last Name:CASASNOVAS
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 1:1738 CALLE AMARILLO
Mailing Address - Street 2:SUITE 207-A
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-3072
Mailing Address - Country:US
Mailing Address - Phone:787-281-0614
Mailing Address - Fax:787-281-0632
Practice Address - Street 1:300 AVE. LAS CUMBRES
Practice Address - Street 2:LAS VISTAS SHOPPING VILLAGE, SUITE 40
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-680-7385
Practice Address - Fax:787-680-7386
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR19821223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics