Healthcare Provider Details

I. General information

NPI: 1164129870
Provider Name (Legal Business Name): CATERPILLAR DENTAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2023
Last Update Date: 02/13/2023
Certification Date: 02/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CATERPILLAR DENTAL PLLC 102 ROUTE 109
WEST BABYLON NY
11704
US

IV. Provider business mailing address

102 ROUTE 109
WEST BABYLON NY
11704
US

V. Phone/Fax

Practice location:
  • Phone: 631-619-0010
  • Fax: 631-983-4774
Mailing address:
  • Phone: 631-619-0010
  • Fax: 631-983-4774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DEONAH JOY CACCIATORE
Title or Position: OFFICE MANAGER
Credential:
Phone: 631-619-0010