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General NPI Number Information
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NPI Number | 1992600027
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Entity Type | Organization
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Legal Business Name | ANGELO CACCIATORE DMD, INC.
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Dates
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Enumeration Date | 10/09/2026
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Last Update Date | 10/09/2026
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Provider Practice Location Address
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Address Line | 12778 RANCHO PENASQUITOS BLVD STE A
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City | SAN DIEGO
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State | CA
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Zip | 92129-2947
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Country | US
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Telephone | 917-468-5582
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 483
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City | SAN LUIS REY
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State | CA
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Zip | 92068-0483
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Country | US
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Telephone | 917-468-5582
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | ANGELO CACCIATORE
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Credential | DMD
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Telephone | 917-468-5582
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State | NULL
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