Provider Demographics
NPI:1043202039
Name:CAHOON, MICHAEL L (DMD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:L
Last Name:CAHOON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 KINGS HWY
Mailing Address - Street 2:STE 107
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-1772
Mailing Address - Country:US
Mailing Address - Phone:302-644-4171
Mailing Address - Fax:302-644-4314
Practice Address - Street 1:750 KINGS HWY
Practice Address - Street 2:STE 107
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-1772
Practice Address - Country:US
Practice Address - Phone:302-644-4171
Practice Address - Fax:302-644-4314
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEGI-00009441223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000911802Medicaid
T84938Medicare UPIN
DE0000911802Medicaid