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CHARISSE L. CASWELL DMD
Pediatric Dentistry >> Dentist >> Dental ProvidersRegistrant NPI Number: 1326013921
Individual Registrant: CHARISSE L. CASWELL DMD
Gender: F
Not Sole Proprietor
Gender: F
Not Sole Proprietor
Location and contact information for practice:
120 HANDLEY RD SUITE 210 TYRONE, GA 30290-2177 US
Tel: 770-632-7090 Fax: 770-632-7075
Tel: 770-632-7090 Fax: 770-632-7075
Contact information for business:
120 HANDLEY RD SUITE 210 TYRONE, GA 30290-2177 US
Tel: 770-632-7090 Fax: 770-632-7075
Tel: 770-632-7090 Fax: 770-632-7075
Registration Information:
NPI: 1326013921
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 1223P0221X | Dental Providers Dentist Pediatric Dentistry | GA | DN013163 |
| N | 1223G0001X | Dental Providers Dentist | GA | DN013163 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
| 773054619G | GA | 05 | |
| 773054619H | GA | 05 |
