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General NPI Number Information
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NPI Number | 1235397357
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Entity Type | Organization
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Legal Business Name | MARK H CACERES DMD LLC
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Dates
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Enumeration Date | 05/27/2008
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Last Update Date | 05/27/2008
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Provider Practice Location Address
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Address Line | 4485 N TOWN SQ SUITE 108
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City | POWDER SPRINGS
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State | GA
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Zip | 30127-2242
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Country | US
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Telephone | 770-943-3344
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Fax | 770-943-2727
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Provider Business Mailing Address
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Address Line | 4485 N TOWN SQ SUITE 108
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City | POWDER SPRINGS
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State | GA
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Zip | 30127-2242
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Country | US
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Telephone | 770-943-3344
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Fax | 770-943-2727
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Authorized Official
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Title or Position | DENTIST
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Name | DR. MARK H CACERES
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Credential | DMD
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Telephone | 770-943-3344
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 10991
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License Number State | GA
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