Provider Demographics
NPI:1003433640
Name:CACHO, DENISE MARIE (DMD)
Entity Type:Individual
Prefix:DR
First Name:DENISE
Middle Name:MARIE
Last Name:CACHO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:DENISE
Other - Middle Name:MARIE
Other - Last Name:CACHO-JUAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:EAST BLISS DENTAL CLINIC
Mailing Address - Street 2:21227 TORCH ST
Mailing Address - City:FORT BLISS
Mailing Address - State:TX
Mailing Address - Zip Code:79918
Mailing Address - Country:US
Mailing Address - Phone:915-742-9297
Mailing Address - Fax:
Practice Address - Street 1:EAST BLISS DENTAL CLINIC
Practice Address - Street 2:21227 TORCH ST
Practice Address - City:FORT BLISS
Practice Address - State:TX
Practice Address - Zip Code:79918
Practice Address - Country:US
Practice Address - Phone:915-742-9297
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-30
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD11244122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1003433640Medicaid