Provider Demographics
NPI:1568421170
Name:CACCHIO, JOHN NICOLAS (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:NICOLAS
Last Name:CACCHIO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9300 FRANKFORD AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19114-2861
Mailing Address - Country:US
Mailing Address - Phone:215-331-9576
Mailing Address - Fax:215-331-9577
Practice Address - Street 1:9300 FRANKFORD AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-2861
Practice Address - Country:US
Practice Address - Phone:215-331-9576
Practice Address - Fax:215-331-9577
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS024040L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice