Provider Demographics
NPI:1588865240
Name:CACERES, JOHANNY (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHANNY
Middle Name:
Last Name:CACERES
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 1:3860 SW 8TH ST STE 201
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-3018
Mailing Address - Country:US
Mailing Address - Phone:305-552-1193
Mailing Address - Fax:
Practice Address - Street 1:3860 SW 8TH ST STE 201
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-3018
Practice Address - Country:US
Practice Address - Phone:305-552-1193
Practice Address - Fax:305-443-0008
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN187551223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery