Provider Demographics
NPI:1053889105
Name:CASADO, CANDIDA M
Entity type:Individual
Prefix:
First Name:CANDIDA
Middle Name:M
Last Name:CASADO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5810 CORAL RIDGE DRIVE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33076
Mailing Address - Country:US
Mailing Address - Phone:954-905-1290
Mailing Address - Fax:
Practice Address - Street 1:5810 CORAL RIDGE DR STE 130
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33076-3375
Practice Address - Country:US
Practice Address - Phone:954-905-1290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-07
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN238321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice