Provider Demographics
NPI:1700939717
Name:CAVES, SAMUEL ALBERT (DMD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:ALBERT
Last Name:CAVES
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:S.
Other - Middle Name:ALBERT
Other - Last Name:CAVES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:5900 RIVER RD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-4578
Mailing Address - Country:US
Mailing Address - Phone:706-571-0079
Mailing Address - Fax:706-571-0355
Practice Address - Street 1:5900 RIVER RD
Practice Address - Street 2:SUITE 302
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-4578
Practice Address - Country:US
Practice Address - Phone:706-571-0079
Practice Address - Fax:706-571-0355
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA121121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice