Provider Demographics
NPI:1518255207
Name:CAVANAGH, ANTHONY J (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:J
Last Name:CAVANAGH
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 1:397 STATE ST
Mailing Address - Street 2:APT. #2D
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12210-1215
Mailing Address - Country:US
Mailing Address - Phone:315-289-9992
Mailing Address - Fax:
Practice Address - Street 1:1301 RIVER ST
Practice Address - Street 2:SUITE 203
Practice Address - City:VALATIE
Practice Address - State:NY
Practice Address - Zip Code:12184-9694
Practice Address - Country:US
Practice Address - Phone:518-758-9291
Practice Address - Fax:518-758-9262
Is Sole Proprietor?:No
Enumeration Date:2011-07-14
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY056042-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice