MEDICARE: DR. CAMERON FRANK CAVOLA D.M.D., M.D.

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	2014-00442	NC

General Provider Information

NPI Number	:	1992967608
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CAMERON FRANK CAVOLA D.M.D., M.D.

Provider Business Mailing Address
First Line	:	5904 SIX FORKS RD
Second Line	:	STE 101
City	:	RALEIGH
State	:	NC
Zip	:	27609-3838
Country	:	US
Telephone Number	:	919-322-4500
Fax Number	:	919-322-4495

Provider Business Practice Location Address
First Line	:	5904 SIX FORKS RD
Second Line	:	STE 101
City	:	RALEIGH
State	:	NC
Zip	:	27609-3838
Country	:	US
Telephone Number	:	919-322-4500
Fax Number	:	919-322-4495

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

Provider Enumeration Date	:	06/25/2008
Last Update Date	:	07/07/2014

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