Provider Demographics
NPI:1235397357
Name:MARK H CACERES DMD LLC
Entity Type:Organization
Organization Name:MARK H CACERES DMD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:H
Authorized Official - Last Name:CACERES
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:770-943-3344
Mailing Address - Street 1:4485 N TOWN SQ
Mailing Address - Street 2:SUITE 108
Mailing Address - City:POWDER SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30127-2242
Mailing Address - Country:US
Mailing Address - Phone:770-943-3344
Mailing Address - Fax:770-943-2727
Practice Address - Street 1:4485 N TOWN SQ
Practice Address - Street 2:SUITE 108
Practice Address - City:POWDER SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30127-2242
Practice Address - Country:US
Practice Address - Phone:770-943-3344
Practice Address - Fax:770-943-2727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-27
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA10991261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental