Healthcare Provider Details

I. General information

NPI: 1972250496
Provider Name (Legal Business Name): ELIZABETH DIANA CAGGIANO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2022
Last Update Date: 07/17/2025
Certification Date: 07/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14425 W MCDOWELL RD STE F106
GOODYEAR AZ
85395-2516
US

IV. Provider business mailing address

5008 BEECH ST
BELLAIRE TX
77401-3408
US

V. Phone/Fax

Practice location:
  • Phone: 623-257-7333
  • Fax:
Mailing address:
  • Phone: 713-206-1553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD011578
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: