Basic Information
| Provider Information | |||||||||
| NPI: | 1053889105 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CASADO | ||||||||
| FirstName: | CANDIDA | ||||||||
| MiddleName: | M | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5810 CORAL RIDGE DRIVE | ||||||||
| Address2: | SUITE 130 | ||||||||
| City: | CORAL SPRINGS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33076 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9549051290 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5810 CORAL RIDGE DR STE 130 | ||||||||
| Address2: | |||||||||
| City: | CORAL SPRINGS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330763375 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9549051290 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2018 | ||||||||
| LastUpdateDate: | 11/07/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | DN23832 | FL | Y | Dental Providers | Dentist | General Practice |
No ID Information.