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General NPI Number Information
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NPI Number | 1780932830
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Entity Type | Organization
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Legal Business Name | CLAUDIA CAVALLINO DDS, LLC
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Dates
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Enumeration Date | 08/21/2012
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Last Update Date | 08/21/2012
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Provider Practice Location Address
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Address Line | 4752 HIGHWAY 311 STE 115
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City | HOUMA
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State | LA
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Zip | 70360-2810
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Country | US
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Telephone | 985-868-8331
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Fax | 985-868-8332
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Provider Business Mailing Address
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Address Line | 4752 HIGHWAY 311 STE 115
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City | HOUMA
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State | LA
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Zip | 70360-2810
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Country | US
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Telephone | 985-868-8331
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Fax | 985-868-8332
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Authorized Official
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Title or Position | DENTIST - OWNER
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Name | DR. CLAUDIA ANNE CAVALLINO
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Credential | D.D.S.
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Telephone | 985-868-8331
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 5392
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License Number State | LA
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