Provider Demographics
NPI:1861481061
Name:CAVALLARI, ALBERT PHILLIP (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:PHILLIP
Last Name:CAVALLARI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 PROFESSIONAL PKWY
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14094-5368
Mailing Address - Country:US
Mailing Address - Phone:716-433-3883
Mailing Address - Fax:716-434-1717
Practice Address - Street 1:130 PROFESSIONAL PKWY
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14094-5368
Practice Address - Country:US
Practice Address - Phone:716-433-3883
Practice Address - Fax:716-434-1717
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY395901223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics