Provider Demographics
NPI:1023747185
Name:MCLEOD, CASI JO (DMD)
Entity type:Individual
Prefix:
First Name:CASI
Middle Name:JO
Last Name:MCLEOD
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 E BENNETT AVE
Mailing Address - Street 2:
Mailing Address - City:MARTIN
Mailing Address - State:SD
Mailing Address - Zip Code:57551-2203
Mailing Address - Country:US
Mailing Address - Phone:605-685-1046
Mailing Address - Fax:
Practice Address - Street 1:103 E BENNETT AVE
Practice Address - Street 2:
Practice Address - City:MARTIN
Practice Address - State:SD
Practice Address - Zip Code:57551-2203
Practice Address - Country:US
Practice Address - Phone:605-685-1046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-06
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDD13601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty