MEDICARE: DR. MARK A. CAGGIANO DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	00006697	WA

General Provider Information

NPI Number	:	1407932403
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK A. CAGGIANO DDS

Provider Business Mailing Address
First Line	:	4000 EAST MADISON STREET
Second Line	:	SUITE 201
City	:	SEATTLE
State	:	WA
Zip	:	98112-9811
Country	:	US
Telephone Number	:	206-323-5677
Fax Number	:	206-323-7463

Provider Business Practice Location Address
First Line	:	4000 E MADISON ST
Second Line	:	SUITE 201
City	:	SEATTLE
State	:	WA
Zip	:	98112-3160
Country	:	US
Telephone Number	:	206-323-5677
Fax Number	:	206-323-7463

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/31/2006
Last Update Date	:	07/08/2007

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