Healthcare Provider Details

I. General information

NPI: 1598093288
Provider Name (Legal Business Name): CAROLINE M. KACER DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2009
Last Update Date: 09/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6471 N. LA CHOLLA BLVD 101
TUCSON AZ
85741
US

IV. Provider business mailing address

6471 N LA CHOLLA BLVD 101
TUCSON AZ
85741-3141
US

V. Phone/Fax

Practice location:
  • Phone: 520-742-6136
  • Fax: 520-742-5721
Mailing address:
  • Phone: 520-742-6136
  • Fax: 520-742-5721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberD7887
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: