| Organization Name: | MARK H CACERES DMD LLC |
| NPI Number: | 1235397357 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MARK H CACERES (DENTIST) |
| Mailing Address: | 4485 N Town Sq Suite 108 Powder Springs |
| State: | GA US |
| Postal Code: | 301272242 |
| Phone Number: | 7709433344 |
| Fax Number: | 7709432727 |
| NPI Enumeration Date: | 05/27/2008 |
| NPI Last Update Date: | 05/27/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | 10991 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |