Provider Demographics
NPI:1972551091
Name:CANNAVA, PAUL ANTHONY (DMD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:ANTHONY
Last Name:CANNAVA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2240 E. WINROW AVE.
Mailing Address - Street 2:US ARMY DENTAL CLINIC COMMAND
Mailing Address - City:FORT HUACHUCA
Mailing Address - State:AZ
Mailing Address - Zip Code:85613-7040
Mailing Address - Country:US
Mailing Address - Phone:520-533-3144
Mailing Address - Fax:
Practice Address - Street 1:2240 E WINROW AVE.
Practice Address - Street 2:US ARMY DENTAL CLINIC COMMAND
Practice Address - City:FORT HUACHUCA
Practice Address - State:AZ
Practice Address - Zip Code:85613-7040
Practice Address - Country:US
Practice Address - Phone:520-533-3144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA128851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice