Provider Demographics
NPI:1558521328
Name:CANNAVO, LAUREN MARIE (DMD)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:MARIE
Last Name:CANNAVO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 BELVIDERE AVE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07882-1461
Mailing Address - Country:US
Mailing Address - Phone:908-689-9797
Mailing Address - Fax:908-689-9757
Practice Address - Street 1:113 BELVIDERE AVE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07882-1461
Practice Address - Country:US
Practice Address - Phone:908-689-9797
Practice Address - Fax:908-689-9757
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-14
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02369700122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist