Provider Demographics
NPI:1073733853
Name:CAVENDISH, MICHELE L (DMD)
Entity Type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:L
Last Name:CAVENDISH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 W ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32202-3801
Mailing Address - Country:US
Mailing Address - Phone:904-353-3303
Mailing Address - Fax:904-353-3634
Practice Address - Street 1:137 W ADAMS ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32202-3801
Practice Address - Country:US
Practice Address - Phone:904-353-3303
Practice Address - Fax:904-353-3634
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN0014542122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist