Provider Demographics
NPI:1003846569
Name:CAGNA, DAVID RICHARD (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:RICHARD
Last Name:CAGNA
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UTHSC COLLEGE OF DENTISTRY
Mailing Address - Street 2:875 UNION AVENUE
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38163-0001
Mailing Address - Country:US
Mailing Address - Phone:901-448-6642
Mailing Address - Fax:901-448-1294
Practice Address - Street 1:UTHSC COLLEGE OF DENTISTRY
Practice Address - Street 2:875 UNION AVENUE
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38163-0001
Practice Address - Country:US
Practice Address - Phone:901-448-6642
Practice Address - Fax:901-448-1294
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS00000083041223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3227620Medicare ID - Type UnspecifiedPERFORMING PROVIDER NO.
TNU53275Medicare UPIN