Provider Demographics
NPI:1881374247
Name:TE, JAN CASEY
Entity type:Individual
Prefix:MR
First Name:JAN CASEY
Middle Name:
Last Name:TE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:179 DEMING ST
Mailing Address - Street 2:#A
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06042
Mailing Address - Country:US
Mailing Address - Phone:212-998-9800
Mailing Address - Fax:
Practice Address - Street 1:179 DEMING ST
Practice Address - Street 2:#A
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06042
Practice Address - Country:US
Practice Address - Phone:860-644-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-20
Last Update Date:2025-09-18
Deactivation Date:2024-05-31
Deactivation Code:
Reactivation Date:2025-09-18
Provider Licenses
StateLicense IDTaxonomies
CT14546122300000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program