Healthcare Provider Details

I. General information

NPI: 1154339075
Provider Name (Legal Business Name): MICHAEL L CAHOON DMD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 05/27/2011
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 NumberG1-0000944
License Number StateDE

VIII. Authorized Official

Name: DR. MACHAEL L CAHOON
Title or Position: OWNER/PRES/DR
Credential: DMD
Phone: 302-644-4171