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General NPI Number Information
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NPI Number | 1033370598
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Entity Type | Individual
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Provider Name | KENNETH J CAVALLARI DDS
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Gender | Male
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Dates
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Enumeration Date | 06/18/2008
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Last Update Date | 09/17/2025
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Provider Practice Location Address
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Address Line | 984 FIRST COLONIAL RD SUITE 300
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City | VIRGINIA BEACH
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State | VA
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Zip | 23454
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Country | US
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Telephone | 757-412-0235
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Fax | 757-381-7123
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Provider Business Mailing Address
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Address Line | 984 FIRST COLONIAL RD SUITE 300
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City | VIRGINIA BEACH
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State | VA
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Zip | 23454
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Country | US
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Telephone | 757-412-0235
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Fax | 757-496-6695
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 0401007923
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License Number State | VA
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