Healthcare Provider Details

I. General information

NPI: 1124145719
Provider Name (Legal Business Name): MARC VINCENT CAUCHON D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14601 N.W. 140 STREET
ALACHUA FL
32615
US

IV. Provider business mailing address

P.O. BOX 1478
ALACHUA FL
32616
US

V. Phone/Fax

Practice location:
  • Phone: 386-418-3636
  • Fax: 386-418-3630
Mailing address:
  • Phone: 386-418-3636
  • Fax: 386-418-3630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN13420
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: