Provider Demographics
NPI:1467479014
Name:CACOVEAN, SNJEZANA (DMD)
Entity Type:Individual
Prefix:DR
First Name:SNJEZANA
Middle Name:
Last Name:CACOVEAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:807 BUCKINGHAM RD
Mailing Address - Street 2:
Mailing Address - City:RYDAL
Mailing Address - State:PA
Mailing Address - Zip Code:19046-2312
Mailing Address - Country:US
Mailing Address - Phone:215-681-5112
Mailing Address - Fax:
Practice Address - Street 1:960 OLD YORK RD STE 102
Practice Address - Street 2:
Practice Address - City:ABINGTON
Practice Address - State:PA
Practice Address - Zip Code:19001-4709
Practice Address - Country:US
Practice Address - Phone:215-576-1833
Practice Address - Fax:215-576-0743
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS19657L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice