Healthcare Provider Details

I. General information

NPI: 1275638173
Provider Name (Legal Business Name): JAMES W CAHILLANE D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 N WISCONSIN ST
HOBART IN
46342-2160
US

IV. Provider business mailing address

407 N WISCONSIN ST
HOBART IN
46342-2160
US

V. Phone/Fax

Practice location:
  • Phone: 219-942-4624
  • Fax: 219-942-5156
Mailing address:
  • Phone: 219-942-4624
  • Fax: 219-942-5156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12007586
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: