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General NPI Number Information
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NPI Number | 1851682041
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Entity Type | Organization
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Legal Business Name | DR. MICHEL DACCACHE ORAL AND MAXILLOFACIAL SURGERY , LTD
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Dates
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Enumeration Date | 04/22/2011
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Last Update Date | 03/30/2017
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Provider Practice Location Address
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Address Line | 1701 W CHARLESTON BLVD SUITE 520
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City | LAS VEGAS
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State | NV
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Zip | 89102-2325
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Country | US
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Telephone | 702-750-9444
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Fax |
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Provider Business Mailing Address
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Address Line | 1701 W CHARLESTON BLVD #520
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City | LAS VEGAS
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State | NV
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Zip | 89102-2325
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Country | US
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Telephone | 702-750-9444
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MICHEL DACCACHE
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Credential |
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Telephone | 775-750-6789
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | S2-112C
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License Number State | NV
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