Michelle Icasiano

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

DS029194L Issued in PA

Practice address

7101 Hoff St. BLDG 9240
USA Dental Activity
Fort Benning, GA 31905

Phone

(706) 544-4530

Fax

(706) 544-1933

NPI assigned

Oct 4, 2006

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1083700793",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7101 HOFF ST. BLDG 9240",
            "address_2": "USA DENTAL ACTIVITY",
            "city": "FORT BENNING",
            "state": "GA",
            "postal_code": "31905",
            "telephone_number": "706-544-4530",
            "fax_number": "706-544-1933"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7101 HOFF ST. BLDG 9240",
            "address_2": "USA DENTAL ACTIVITY",
            "city": "FORT BENNING",
            "state": "GA",
            "postal_code": "31905",
            "telephone_number": "706-544-4530",
            "fax_number": "706-544-1933"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ICASIANO",
        "first_name": "MICHELLE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-04",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "PA",
            "license": "DS029194L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carolyn White Hunter, MSW
• Christian Tyler Hunter, MD
• Emily G Hunter, MD
• Charles Hutchinson, D.O
• Long Phuoc Huynh, DO
• Bruce David Ingold, PA-C
• Kimberly Ann Saya Inouye, DMD
• Thomas Isenovski, DO
• Heather Isom
• Daniel Gerardo Izquierdo, PA

• Oral and Maxillofacial Surgery (Dentist) in Fort Benning, GA
• Providers in Fort Benning, GA by specialty
• Oral and Maxillofacial Surgery (Dentist) in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.