Austin Lucas Cacciaglia, DDS

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

019032889 Issued in IL

Practice address

2160 S 1St Ave
Maywood, IL 60153-3328

Phone

(888) 584-7888

NPI assigned

Sep 30, 2021

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1632960000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684886400000",
    "number": "1043982739",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2274 WINTER RIDGE DR",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496868244"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2160 S 1ST AVE",
            "city": "MAYWOOD",
            "state": "IL",
            "postal_code": "601533328",
            "telephone_number": "888-584-7888"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3D Dental Battalion, 3D MLG",
            "address_2": "Unit 38450 FPO AP",
            "address_purpose": "LOCATION",
            "city": "Okinawa",
            "state": "Okinawa",
            "postal_code": "96373",
            "country_code": "JP",
            "telephone_number": "231-632-1571",
            "country_name": "Japan",
            "address_type": "FGN"
        }
    ],
    "basic": {
        "last_name": "CACCIAGLIA",
        "first_name": "AUSTIN",
        "middle_name": "LUCAS",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-09-30",
        "last_updated": "2023-05-24",
        "certification_date": "2023-05-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "IL",
            "license": "019032889",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Aman Singh Buttar, MD
• Mark Byram
• Scott Willis Byram, M.D.
• Susanna Coers Byram, MD, PHD
• Catherine Byrd
• Sarah Cadden, MD
• Caitlin Rose Cadwalder
• Kirk Edward Cahill, MD
• Sean Mitchell Callahan
• Mitz Francis Calumpang

• Oral and Maxillofacial Surgery (Dentist) in Maywood, IL
• Providers in Maywood, IL by specialty
• Oral and Maxillofacial Surgery (Dentist) in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.