Provider Demographics
NPI:1518016625
Name:CAVA, EUGENIO
Entity Type:Individual
Prefix:
First Name:EUGENIO
Middle Name:
Last Name:CAVA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:796 SILVERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-4950
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1500 BEVILLE RD STE 403
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-5644
Practice Address - Country:US
Practice Address - Phone:386-253-6634
Practice Address - Fax:386-258-8775
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL130451223G0001X
MN104681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice