| NPI | 1689755837 |
|---|---|
| Professional Name | JACK R KAVANAGH |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CA 48478) |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2012-12-12 |