Provider Demographics
NPI:1235137654
Name:CAVOLA, RONALD SCOTT (DDS)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:SCOTT
Last Name:CAVOLA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2005 HONEY CREEK PKWY SE
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-2975
Mailing Address - Country:US
Mailing Address - Phone:770-929-8555
Mailing Address - Fax:770-929-8582
Practice Address - Street 1:2005 HONEY CREEK PKWY SE
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-2975
Practice Address - Country:US
Practice Address - Phone:770-929-8555
Practice Address - Fax:770-929-8582
Is Sole Proprietor?:No
Enumeration Date:2005-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA104771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice