MEDICARE: DR. KAVITA DAVE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry	D012237	AZ
2	390200000X	Student in an Organized Health Care Education/Training Program		DC

General Provider Information

NPI Number	:	1093457673
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KAVITA DAVE

Provider Business Mailing Address
First Line	:	46 LADENTOWN RD
Second Line	:
City	:	POMONA
State	:	NY
Zip	:	10970-2862
Country	:	US
Telephone Number	:	845-553-5833
Fax Number	:

Provider Business Practice Location Address
First Line	:	2533 N 75TH AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85035-1211
Country	:	US
Telephone Number	:	845-553-5833
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/12/2022
Last Update Date	:	06/25/2024

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Directions to “ DR. KAVITA DAVE ” Practice Location

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