Provider Demographics
NPI:1740305804
Name:MCCAWLEY, THOMAS KINCAID (DDS)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:KINCAID
Last Name:MCCAWLEY
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 1:715 SOLAR ISLE DRIVE
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301
Mailing Address - Country:US
Mailing Address - Phone:954-763-4714
Mailing Address - Fax:954-524-0942
Practice Address - Street 1:800 E BROWARD BLVD
Practice Address - Street 2:STE 706
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33301
Practice Address - Country:US
Practice Address - Phone:954-522-3228
Practice Address - Fax:954-522-3423
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5447122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist