MEDICARE: DR. DAVID ANDREW CACCHILLO DDS MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	21439	OH

General Provider Information

NPI Number	:	1174707111
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID ANDREW CACCHILLO DDS MS

Provider Business Mailing Address
First Line	:	7535 E MAIN ST
Second Line	:
City	:	REYNOLDSBURG
State	:	OH
Zip	:	43068-1252
Country	:	US
Telephone Number	:	614-861-8077
Fax Number	:	614-861-2554

Provider Business Practice Location Address
First Line	:	7535 E MAIN ST
Second Line	:
City	:	REYNOLDSBURG
State	:	OH
Zip	:	43068-1252
Country	:	US
Telephone Number	:	614-861-8077
Fax Number	:	614-861-2554

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/27/2007
Last Update Date	:	12/27/2007

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