Provider Demographics
NPI:1306393970
Name:DR. LAWRENCE CACCHIOTTI
Entity Type:Organization
Organization Name:DR. LAWRENCE CACCHIOTTI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SYSTEMS ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:ZEUTENHORST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-966-2200
Mailing Address - Street 1:1111 S. 40TH AVE
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908
Mailing Address - Country:US
Mailing Address - Phone:509-966-2200
Mailing Address - Fax:509-966-9982
Practice Address - Street 1:1111 S 40TH AVE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908-3930
Practice Address - Country:US
Practice Address - Phone:509-966-2200
Practice Address - Fax:509-966-9982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA63121223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty