Provider Demographics
NPI:1174782429
Name:FAWCETT, CARA LYNNE (DDS)
Entity type:Individual
Prefix:DR
First Name:CARA
Middle Name:LYNNE
Last Name:FAWCETT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 MILFORD DR
Mailing Address - Street 2:SUITE 17
Mailing Address - City:HUDSON
Mailing Address - State:OH
Mailing Address - Zip Code:44236-2750
Mailing Address - Country:US
Mailing Address - Phone:330-650-4558
Mailing Address - Fax:330-650-6466
Practice Address - Street 1:45 MILFORD DR
Practice Address - Street 2:SUITE 17
Practice Address - City:HUDSON
Practice Address - State:OH
Practice Address - Zip Code:44236-2750
Practice Address - Country:US
Practice Address - Phone:330-650-4558
Practice Address - Fax:330-650-6466
Is Sole Proprietor?:No
Enumeration Date:2008-06-03
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH18058122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist