Provider Demographics
NPI:1306948880
Name:CAVALARIS, CONSTANTINE JOHN (D D S)
Entity type:Individual
Prefix:DR
First Name:CONSTANTINE
Middle Name:JOHN
Last Name:CAVALARIS
Suffix:
Gender:M
Credentials:D D S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1892 MARBLECLIFF CROSSING CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43204-4966
Mailing Address - Country:US
Mailing Address - Phone:614-486-7416
Mailing Address - Fax:614-488-1619
Practice Address - Street 1:1892 MARBLECLIFF CROSSING CT
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43204-4966
Practice Address - Country:US
Practice Address - Phone:614-486-7416
Practice Address - Fax:614-488-1619
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.011158122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist