Provider Demographics
NPI:1013372408
Name:KACHACHI, LARA (DDS)
Entity Type:Individual
Prefix:DR
First Name:LARA
Middle Name:
Last Name:KACHACHI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 DANVILLE BLVD
Mailing Address - Street 2:SUITE A & B
Mailing Address - City:ALAMO
Mailing Address - State:CA
Mailing Address - Zip Code:94507-1574
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3000 DANVILLE BLVD
Practice Address - Street 2:SUITE A & B
Practice Address - City:ALAMO
Practice Address - State:CA
Practice Address - Zip Code:94507-1574
Practice Address - Country:US
Practice Address - Phone:703-431-7663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-29
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA653021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice