Provider Demographics
NPI:1346335007
Name:CACCHIO, CHAD NATHAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:NATHAN
Last Name:CACCHIO
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 1:1700 W LANE AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43221-3342
Mailing Address - Country:US
Mailing Address - Phone:614-488-1313
Mailing Address - Fax:614-488-1414
Practice Address - Street 1:1700 W LANE AVE STE 100
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43221-3342
Practice Address - Country:US
Practice Address - Phone:614-488-1313
Practice Address - Fax:614-488-1414
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300221601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice