Provider Demographics
NPI:1164838157
Name:ANTHONY D. KAVORINOSDDS,APC
Entity Type:Organization
Organization Name:ANTHONY D. KAVORINOSDDS,APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:KAVORINOS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-591-1745
Mailing Address - Street 1:12604 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-3508
Mailing Address - Country:US
Mailing Address - Phone:909-591-1745
Mailing Address - Fax:
Practice Address - Street 1:12604 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-3508
Practice Address - Country:US
Practice Address - Phone:909-591-1745
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-10
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26439122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty