Provider Demographics
NPI:1952659807
Name:CAVALLINO PEDIATRIC DENTISTRY
Entity Type:Organization
Organization Name:CAVALLINO PEDIATRIC DENTISTRY
Other - Org Name:NEW ORLEANS CHILDRENS DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CLAUDIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:CAVALLINO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:504-833-5528
Mailing Address - Street 1:6264 CANAL BLVD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70124
Mailing Address - Country:US
Mailing Address - Phone:504-833-5528
Mailing Address - Fax:504-833-5542
Practice Address - Street 1:6264 CANAL BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70124
Practice Address - Country:US
Practice Address - Phone:504-833-5528
Practice Address - Fax:504-833-5542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-27
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA53921223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1853925Medicaid