Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Michelle Icasiano

Individual provider Oral and Maxillofacial Surgery (Dentist) · NPI 1083700793

Michelle Icasiano is an Oral and Maxillofacial Surgery (Dentist) in Fort Benning, Georgia. Practices as a sole proprietor. Licensed in Pennsylvania.

Licensed in
PA
In the registry since
2006
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Practice location Address checks out

7101 Hoff St Bldg 9240 Usa Dental Activity
Fort Benning, GA 31905
Phone: (706) 544-4530
Fax: (706) 544-1933
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Specialties & licences

Oral and Maxillofacial Surgery (Dentist) (primary) Taxonomy 1223S0112X · Licence DS029194L (PA)

Record details

NPI number1083700793
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorYes
NPI enumeratedOctober 4, 2006
Last updated in NPPESJuly 8, 2007
Mailing address7101 Hoff St. Bldg 9240, Usa Dental Activity, Fort Benning, GA 31905