Provider Demographics
NPI:1073731824
Name:CAVALLI, BILL THOMAS (DDS)
Entity Type:Individual
Prefix:DR
First Name:BILL
Middle Name:THOMAS
Last Name:CAVALLI
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 1:2522 DANA ST
Mailing Address - Street 2:#207
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94704
Mailing Address - Country:US
Mailing Address - Phone:510-841-4323
Mailing Address - Fax:510-841-4038
Practice Address - Street 1:2522 DANA ST
Practice Address - Street 2:#207
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704
Practice Address - Country:US
Practice Address - Phone:510-841-4323
Practice Address - Fax:510-841-4038
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31446122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist