Individual
CHARISSE L. CASWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
120 HANDLEY RD, SUITE 210, TYRONE, GA 30290-2177
(770) 632-7090
(770) 632-7075
Mailing address
120 HANDLEY RD, SUITE 210, TYRONE, GA 30290-2177
(770) 632-7090
(770) 632-7075
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
DN013163
GA
1223P0221X
Pediatric Dentistry
Primary
DN013163
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
773054619G
—
GA
05
—
773054619H
—
GA
Enumeration date
02/17/2006
Last updated
03/10/2016
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