Provider Demographics
NPI:1033370598
Name:CAVALLARI, KENNETH J (DDS)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:J
Last Name:CAVALLARI
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 1:984 FIRST COLONIAL RD STE 108
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-3196
Mailing Address - Country:US
Mailing Address - Phone:757-412-0235
Mailing Address - Fax:757-496-6695
Practice Address - Street 1:984 FIRST COLONIAL RD STE 108
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-3196
Practice Address - Country:US
Practice Address - Phone:757-412-0235
Practice Address - Fax:757-496-6695
Is Sole Proprietor?:No
Enumeration Date:2008-06-18
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010079231223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics