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General NPI Number Information
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NPI Number | 1144457268
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Entity Type | Individual
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Provider Name | CASSIDY MIGAN LAVORINI-DOYLE D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 06/16/2009
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Last Update Date | 09/03/2015
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Provider Practice Location Address
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Address Line | 363 15TH ST
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City | OAKLAND
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State | CA
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Zip | 94612-3303
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Country | US
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Telephone | 510-444-4334
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Fax |
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Provider Business Mailing Address
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Address Line | 525 MANDANA BLVD APT 311
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City | OAKLAND
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State | CA
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Zip | 94610-2260
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Country | US
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Telephone | 925-963-3660
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Fax |
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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 | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 62367
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License Number State | CA
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