Provider Demographics
NPI:1003959594
Name:CAVIRIS, PETER K (DMD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:K
Last Name:CAVIRIS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3812 30TH AVE
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11103-3336
Mailing Address - Country:US
Mailing Address - Phone:718-274-2149
Mailing Address - Fax:718-274-2149
Practice Address - Street 1:3812 30TH AVE
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11103-3336
Practice Address - Country:US
Practice Address - Phone:718-274-2149
Practice Address - Fax:718-274-2149
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0437721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice