Provider Demographics
NPI:1215592340
Name:CAVITY COMMANDO'S DENTISTRY FOR KIDS PLLC
Entity Type:Organization
Organization Name:CAVITY COMMANDO'S DENTISTRY FOR KIDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LANDON
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:SEARS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:610-608-7019
Mailing Address - Street 1:3480 NW 85TH CT APT 116
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33122-1958
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1265 INTERSTATE DR STE 101
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-5198
Practice Address - Country:US
Practice Address - Phone:931-783-1491
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-03
Last Update Date:2019-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty