Healthcare Provider Details

I. General information

NPI: 1104970698
Provider Name (Legal Business Name): LAWRENCE FRANK CACCHIOTTI D.D.S., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 S 40TH AVE
YAKIMA WA
98908-3930
US

IV. Provider business mailing address

1111 S 40TH AVE
YAKIMA WA
98908-3930
US

V. Phone/Fax

Practice location:
  • Phone: 509-966-2200
  • Fax: 509-966-9982
Mailing address:
  • Phone: 509-966-2200
  • Fax: 509-966-9982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number6312
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: