MEDICARE: DR. MICHEL DACCACHE DDS

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	DS037022	PA
2	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	S2-112C	NV

General Provider Information

NPI Number	:	1285881243
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHEL DACCACHE DDS

Provider Business Mailing Address
First Line	:	2199 STAGE STOP DR
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89052-5825
Country	:	US
Telephone Number	:	775-750-6789
Fax Number	:

Provider Business Practice Location Address
First Line	:	1701 W CHARLESTON BLVD STE 520
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-2309
Country	:	US
Telephone Number	:	702-750-9444
Fax Number	:

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

Provider Enumeration Date	:	08/21/2008
Last Update Date	:	03/30/2017

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