Individual
MICHELLE ICASIANO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
7101 HOFF ST. BLDG 9240, USA DENTAL ACTIVITY, FORT BENNING, GA 31905
(706) 544-4530
(706) 544-1933
Mailing address
7101 HOFF ST. BLDG 9240, USA DENTAL ACTIVITY, FORT BENNING, GA 31905
(706) 544-4530
(706) 544-1933
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
DS029194L
PA
Other
Enumeration date
10/04/2006
Last updated
07/08/2007
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