Provider Demographics
NPI:1447350095
Name:CACOS, PETER P (DDS)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:P
Last Name:CACOS
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 1:1244 VIA CORONEL
Mailing Address - Street 2:
Mailing Address - City:PALOS VERDES ESTATES
Mailing Address - State:CA
Mailing Address - Zip Code:90274-1992
Mailing Address - Country:US
Mailing Address - Phone:310-809-6899
Mailing Address - Fax:
Practice Address - Street 1:3440 LOMITA BLVD STE 340
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-4887
Practice Address - Country:US
Practice Address - Phone:310-530-9893
Practice Address - Fax:310-530-5756
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD58721223G0001X
CA58980122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice