Provider Demographics
NPI:1386781839
Name:CAVALLINO, CLAUDIA (DDS)
Entity type:Individual
Prefix:DR
First Name:CLAUDIA
Middle Name:
Last Name:CAVALLINO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1340 W TUNNEL BLVD
Mailing Address - Street 2:SUITE 530
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-2801
Mailing Address - Country:US
Mailing Address - Phone:985-868-8331
Mailing Address - Fax:985-868-8332
Practice Address - Street 1:1340 W TUNNEL BLVD
Practice Address - Street 2:SUITE 530
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-2801
Practice Address - Country:US
Practice Address - Phone:985-868-8331
Practice Address - Fax:985-868-8332
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA53921223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1853925Medicaid