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1780800243
MATHEW KAVANAUGH
FORT WAYNE, IN
NPI
1780800243
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
122300000X Dentist
(Licence: IN 12010783A)
Enumeration Date
2007-04-17
Last Update Date
2007-07-08
Business Address
Dr. MATHEW KAVANAUGH DDS
2828 E STATE BLVD SUITE B
FORT WAYNE, IN 46805-4761
Phone number: 260-482-6689
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Mailing Address
Dr. MATHEW KAVANAUGH DDS
2828 E STATE BLVD SUITE B
FORT WAYNE, IN 46805-4761
Phone number: 260-482-6689
Copy
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