Provider Demographics
NPI:1942199047
Name:COLESON, CASEY (DDS)
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:COLESON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:458 COUNTY ROAD 514
Mailing Address - Street 2:
Mailing Address - City:RIENZI
Mailing Address - State:MS
Mailing Address - Zip Code:38865
Mailing Address - Country:US
Mailing Address - Phone:731-439-6665
Mailing Address - Fax:
Practice Address - Street 1:900 E SHILOH RD
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-2620
Practice Address - Country:US
Practice Address - Phone:662-287-1171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-02
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1111761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice