Provider Demographics
NPI:1376791251
Name:CAVANESS, GARY FRANK JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:FRANK
Last Name:CAVANESS
Suffix:JR
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 1:8301 BRIARWOOD ST STE 202
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99518-3333
Mailing Address - Country:US
Mailing Address - Phone:907-349-3569
Mailing Address - Fax:
Practice Address - Street 1:8301 BRIARWOOD ST STE 202
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99518-3333
Practice Address - Country:US
Practice Address - Phone:907-349-3569
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-03
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7078714-99221223G0001X
AK13791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice