Provider Demographics
NPI:1164556528
Name:CAWLEY, HENRY PATRICK (DMD)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:PATRICK
Last Name:CAWLEY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 VIRGINIA AVE N
Mailing Address - Street 2:
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31794-4250
Mailing Address - Country:US
Mailing Address - Phone:229-387-0700
Mailing Address - Fax:229-387-0705
Practice Address - Street 1:611 VIRGINIA AVE N
Practice Address - Street 2:
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31794-4250
Practice Address - Country:US
Practice Address - Phone:229-387-0700
Practice Address - Fax:229-387-0705
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN010665122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist