Provider Demographics
NPI:1053554329
Name:CASEY, MICHAEL FRANCIS
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:FRANCIS
Last Name:CASEY
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:MIKE
Other - Middle Name:F
Other - Last Name:CASEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:PO BOX 929
Mailing Address - Street 2:
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-0929
Mailing Address - Country:US
Mailing Address - Phone:509-747-7134
Mailing Address - Fax:
Practice Address - Street 1:2712 N CHASE RD
Practice Address - Street 2:
Practice Address - City:LIBERTY LAKE
Practice Address - State:WA
Practice Address - Zip Code:99019-8632
Practice Address - Country:US
Practice Address - Phone:509-747-7134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-15
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000043261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice