| Doctor Name: | GLEN EDWIN CASPER |
| NPI Number: | 1194099135 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LD |
| License Number: | DT-DO 364493 |
| Business Practice Address: | 3436 Broadway St North Bend, OR - 974591202 |
| Business Phone Number: | 5417566313 |
| Business Fax Number: | 5418082722 |
| Mailing Address: | 3436 Broadway St, NORTH BEND |
| State: | OR |
| Postal Code: | 974591202 |
| Phone Number: | 5417566313 |
| Fax Number: | 5418082722 |
| NPI Enumeration Date: | 03/07/2012 |
| NPI Last Update Date: | 03/07/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 122400000X |
| License Number: | DT-DO 364493 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OR |
| Taxonomy Type: | Dental Providers |
| Taxonomy Classification: | Denturist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |