Provider Demographics
NPI:1962241570
Name:CACIOPPO, SOPHIA OLIVIA (DDS)
Entity type:Individual
Prefix:DR
First Name:SOPHIA
Middle Name:OLIVIA
Last Name:CACIOPPO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2568 KISMET ST
Mailing Address - Street 2:
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072-5453
Mailing Address - Country:US
Mailing Address - Phone:504-228-3601
Mailing Address - Fax:
Practice Address - Street 1:309 GRETNA BLVD
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70053-4973
Practice Address - Country:US
Practice Address - Phone:504-366-5611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-22
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA7523122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist