Provider Demographics
NPI:1952194219
Name:CASANAS MARRERO, JORGE LUIS (DMD)
Entity type:Individual
Prefix:DR
First Name:JORGE
Middle Name:LUIS
Last Name:CASANAS MARRERO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13105 SW 248TH ST APT 202
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-6055
Mailing Address - Country:US
Mailing Address - Phone:786-227-0873
Mailing Address - Fax:
Practice Address - Street 1:747 PONCE DE LEON BLVD STE 401
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-2073
Practice Address - Country:US
Practice Address - Phone:786-227-0873
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-28
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL302771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice