Provider Demographics
NPI:1265147268
Name:THOMAS E KAVANAGH DDS INC
Entity type:Organization
Organization Name:THOMAS E KAVANAGH DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:E
Authorized Official - Last Name:KAVANAGH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:440-241-1749
Mailing Address - Street 1:1417 MARLOWE AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-4318
Mailing Address - Country:US
Mailing Address - Phone:216-221-7500
Mailing Address - Fax:216-221-2430
Practice Address - Street 1:1417 MARLOWE AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-4318
Practice Address - Country:US
Practice Address - Phone:216-221-7500
Practice Address - Fax:216-221-2430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-16
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty