MEDICARE: DR. MICHAEL P. MCCAFFERTY 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	1223G0001X	General Practice Dentistry	019020122	IL

General Provider Information

NPI Number	:	1366595795
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL P. MCCAFFERTY DDS

Provider Business Mailing Address
First Line	:	7777 LAKE ST
Second Line	:	SUITE 108
City	:	RIVER FOREST
State	:	IL
Zip	:	60305-1734
Country	:	US
Telephone Number	:	708-366-7840
Fax Number	:

Provider Business Practice Location Address
First Line	:	7777 LAKE ST
Second Line	:	SUITE 108
City	:	RIVER FOREST
State	:	IL
Zip	:	60305-1734
Country	:	US
Telephone Number	:	708-366-7840
Fax Number	:

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

Provider Enumeration Date	:	01/19/2007
Last Update Date	:	07/08/2007

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