Provider Demographics
NPI:1154339075
Name:MICHAEL L CAHOON DMD PA
Entity type:Organization
Organization Name:MICHAEL L CAHOON DMD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRES/DR
Authorized Official - Prefix:DR
Authorized Official - First Name:MACHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:CAHOON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:302-644-4171
Mailing Address - Street 1:750 KINGS HWY
Mailing Address - Street 2:STE 107
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-1772
Mailing Address - Country:US
Mailing Address - Phone:302-644-4171
Mailing Address - Fax:302-644-4314
Practice Address - Street 1:750 KINGS HWY
Practice Address - Street 2:STE 107
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-1772
Practice Address - Country:US
Practice Address - Phone:302-644-4171
Practice Address - Fax:302-644-4314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2011-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEG1-00009441223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000911802Medicaid
DE0000911802Medicaid
T84938Medicare UPIN