Provider Demographics
NPI:1285881243
Name:DACCACHE, MICHEL (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHEL
Middle Name:
Last Name:DACCACHE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2199 STAGE STOP DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-5825
Mailing Address - Country:US
Mailing Address - Phone:775-750-6789
Mailing Address - Fax:
Practice Address - Street 1:1701 W CHARLESTON BLVD STE 520
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-2309
Practice Address - Country:US
Practice Address - Phone:702-750-9444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-21
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS037022122300000X
NVS2-112C1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist