Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 7913 | NC |
NPI | 1114078862 |
---|---|
Provider Name | Dr. Mark Worthington Casey |
First Address | Raleigh, NC 27615-1553 |
Second Address | Raleigh, NC 27699-2501 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/01/2007 |
Last Update Date | 08/07/2007 |