Healthcare Provider Details

I. General information

NPI: 1730195975
Provider Name (Legal Business Name): NORMAN J CAVANAGH DMD, MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 07/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

399 FARMINGTON AVE SUITE 200
FARMINGTON CT
06032-1936
US

IV. Provider business mailing address

17 TALCOTT NOTCH RD
FARMINGTON CT
06032-1818
US

V. Phone/Fax

Practice location:
  • Phone: 860-548-7338
  • Fax: 860-524-2654
Mailing address:
  • Phone: 860-524-2626
  • Fax: 860-677-5029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number006642
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code2082S0099X
TaxonomyPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician
License Number034915
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: