Provider Demographics
NPI:1104365246
Name:THOMAS K. MCCAWLEY, D.D.S.,PA
Entity Type:Organization
Organization Name:THOMAS K. MCCAWLEY, D.D.S.,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:KINCAID
Authorized Official - Last Name:MCCAWLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:954-522-3228
Mailing Address - Street 1:800 E BROWARD BLVD STE 706
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-2085
Mailing Address - Country:US
Mailing Address - Phone:954-522-3228
Mailing Address - Fax:
Practice Address - Street 1:800 E BROWARD BLVD STE 706
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33301-2085
Practice Address - Country:US
Practice Address - Phone:954-522-3228
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-22
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN54471223P0300X
FLDN200651223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty