MEDICARE: DR. ANGELA M CACCIATORE 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	122300000X	Dentist	40341	CA

General Provider Information

NPI Number	:	1437357290
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANGELA M CACCIATORE DDS

Provider Business Mailing Address
First Line	:	720 NORTH EL CAMINO REAL
Second Line	:
City	:	SAN MATEO
State	:	CA
Zip	:	94401-3714
Country	:	US
Telephone Number	:	650-347-2583
Fax Number	:	650-347-1021

Provider Business Practice Location Address
First Line	:	720 NORTH EL CAMINO REAL
Second Line	:
City	:	SAN MATEO
State	:	CA
Zip	:	94401-3714
Country	:	US
Telephone Number	:	650-347-2583
Fax Number	:	650-347-1021

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

Provider Enumeration Date	:	07/03/2007
Last Update Date	:	07/08/2007

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