Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 1748 | HI |
NPI | 1063567113 |
---|---|
Provider Name | Dr. Edmund Anthony Cassella |
First Address | Honolulu, HI 96814-4407 |
Second Address | Honolulu, HI 96814-4407 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2007 |
Last Update Date | 08/07/2007 |