Provider Demographics
NPI:1043428550
Name:CAVALLARO, ROSEANN (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROSEANN
Middle Name:
Last Name:CAVALLARO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 ANN ST
Mailing Address - Street 2:
Mailing Address - City:GREENLAWN
Mailing Address - State:NY
Mailing Address - Zip Code:11740-1201
Mailing Address - Country:US
Mailing Address - Phone:631-757-2383
Mailing Address - Fax:
Practice Address - Street 1:16 ANN ST
Practice Address - Street 2:
Practice Address - City:GREENLAWN
Practice Address - State:NY
Practice Address - Zip Code:11740
Practice Address - Country:US
Practice Address - Phone:631-757-2383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0439631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice