Provider Demographics
NPI:1811105927
Name:CAVIGLI, PAUL RICHARD (DDS)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:RICHARD
Last Name:CAVIGLI
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 1:688 CALIFORNIA BLVD
Mailing Address - Street 2:STE A
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-2560
Mailing Address - Country:US
Mailing Address - Phone:805-544-6378
Mailing Address - Fax:
Practice Address - Street 1:688 CALIFORNIA BLVD
Practice Address - Street 2:STE A
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-2560
Practice Address - Country:US
Practice Address - Phone:805-544-6378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA249521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice