Provider Demographics
NPI:1669501847
Name:CAVAGNOLO, STEVEN F (DDS)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:F
Last Name:CAVAGNOLO
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 1:1931 SYCAMORE LN
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-0844
Mailing Address - Country:US
Mailing Address - Phone:530-753-7600
Mailing Address - Fax:
Practice Address - Street 1:1931 SYCAMORE LN
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-0844
Practice Address - Country:US
Practice Address - Phone:530-753-7600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD237171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice