MEDICARE: DR. KATHRYN MARIE GAVALAS DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	22572	FL

General Provider Information

NPI Number	:	1831621762
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATHRYN MARIE GAVALAS DMD

Provider Business Mailing Address
First Line	:	1280 TIMBERLANE RD
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32312-1710
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1280 TIMBERLANE RD
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32312-1710
Country	:	US
Telephone Number	:	561-315-7091
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/30/2017
Last Update Date	:	03/04/2026

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