Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | D11244 | OR |
NPI | 1003433640 |
---|---|
Provider Name | Dr. Denise Marie Cacho |
First Address | Fort Carson, CO 80913 |
Second Address | Fort Carson, CO 80913 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2020 |
Last Update Date | 30/06/2020 |