Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 035045 | NY |
NPI | 1013030816 |
---|---|
Provider Name | Dr. Michael Neil Cassese |
First Address | Kenmore, NY 14223-1201 |
Second Address | Kenmore, NY 14223-1201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2007 |
Last Update Date | 08/07/2007 |