Provider Demographics
NPI:1851682041
Name:DR. MICHEL DACCACHE ORAL AND MAXILLOFACIAL SURGERY , LTD
Entity Type:Organization
Organization Name:DR. MICHEL DACCACHE ORAL AND MAXILLOFACIAL SURGERY , LTD
Other - Org Name:ORAL AND MAXILLOFACIAL SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DACCACHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-750-6789
Mailing Address - Street 1:1701 W CHARLESTON BLVD
Mailing Address - Street 2:#520
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-2325
Mailing Address - Country:US
Mailing Address - Phone:702-750-9444
Mailing Address - Fax:
Practice Address - Street 1:1701 W CHARLESTON BLVD
Practice Address - Street 2:SUITE 520
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-2325
Practice Address - Country:US
Practice Address - Phone:702-750-9444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-22
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVS2-112C1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty