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General NPI Number Information
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NPI Number | 1083103311
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Entity Type | Organization
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Legal Business Name | CAVALANCIA ORTHODONTIC GROUP, PLLC
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Dates
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Enumeration Date | 05/02/2018
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Last Update Date | 05/02/2018
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Provider Practice Location Address
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Address Line | 152 N 5TH ST
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City | INDIANA
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State | PA
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Zip | 15701-1983
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Country | US
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Telephone | 724-463-7700
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Fax | 724-463-7738
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Provider Business Mailing Address
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Address Line | 152 N 5TH ST
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City | INDIANA
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State | PA
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Zip | 15701-1983
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Country | US
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Telephone | 724-463-7700
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Fax | 724-463-7738
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Authorized Official
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Title or Position | OWNER/DOCTOR
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Name | DR. JEFFREY A CAVALANCIA
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Credential | DDS, MSDD
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Telephone | 724-463-7700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | DS039961
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | DS041199
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | DS023571L
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License Number State | PA
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