Healthcare Provider Details

I. General information

NPI: 1043202039
Provider Name (Legal Business Name): MICHAEL L CAHOON DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/17/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 KINGS HWY STE 107
LEWES DE
19958-1772
US

IV. Provider business mailing address

750 KINGS HWY STE 107
LEWES DE
19958-1772
US

V. Phone/Fax

Practice location:
  • Phone: 302-644-4171
  • Fax: 302-644-4314
Mailing address:
  • Phone: 302-644-4171
  • Fax: 302-644-4314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberGI-0000944
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: