Provider Demographics
NPI:1710107917
Name:CACCO, HOWARD L (DMD)
Entity Type:Individual
Prefix:
First Name:HOWARD
Middle Name:L
Last Name:CACCO
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 1:4792 STATE ROUTE 66
Mailing Address - Street 2:
Mailing Address - City:APOLLO
Mailing Address - State:PA
Mailing Address - Zip Code:15613
Mailing Address - Country:US
Mailing Address - Phone:724-727-3367
Mailing Address - Fax:
Practice Address - Street 1:4792 STATE ROUTE 66
Practice Address - Street 2:
Practice Address - City:APOLLO
Practice Address - State:PA
Practice Address - Zip Code:15613
Practice Address - Country:US
Practice Address - Phone:724-727-3367
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS020721L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist