Provider Demographics
NPI:1164874525
Name:PETER K. CAVIRIS DMD, PLLC
Entity Type:Organization
Organization Name:PETER K. CAVIRIS DMD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:K
Authorized Official - Last Name:CAVIRIS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:718-274-2149
Mailing Address - Street 1:3812 30TH AVE
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11103-3351
Mailing Address - Country:US
Mailing Address - Phone:718-274-2149
Mailing Address - Fax:718-274-7974
Practice Address - Street 1:3812 30TH AVE
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11103-3351
Practice Address - Country:US
Practice Address - Phone:718-274-2149
Practice Address - Fax:718-274-7974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-11
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0437711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty