Provider Demographics
NPI:1225143829
Name:CACHO, WILNER CLIFFORD (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILNER
Middle Name:CLIFFORD
Last Name:CACHO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:903 W CENTER ST
Mailing Address - Street 2:STE 5
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95337-7315
Mailing Address - Country:US
Mailing Address - Phone:209-824-0214
Mailing Address - Fax:209-824-0812
Practice Address - Street 1:903 W CENTER ST
Practice Address - Street 2:STE 5
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95337-7315
Practice Address - Country:US
Practice Address - Phone:209-824-0214
Practice Address - Fax:209-824-0812
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA393761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice