Provider Demographics
NPI:1679828149
Name:DR. HELEN CARDACIOTTO, DMD, FAMILY DENTISTRY, LLC
Entity Type:Organization
Organization Name:DR. HELEN CARDACIOTTO, DMD, FAMILY DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:V
Authorized Official - Last Name:CARDACIOTTO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:228-207-0046
Mailing Address - Street 1:15816 LEMOYNE BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39532-4019
Mailing Address - Country:US
Mailing Address - Phone:228-207-0046
Mailing Address - Fax:
Practice Address - Street 1:15816 LEMOYNE BLVD STE A
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39532-4019
Practice Address - Country:US
Practice Address - Phone:228-207-0046
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-19
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3576101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty