Organization
KENNETH J. CAVALLARI, DDS, PC
Active
Other names
Tidewater Laser Perio & Implants
Organization subpart
No
Provider details
NPI number
Authorized official
JENNY GARCIA-ROCHA (SR CREDENTIALING TEAM LEAD)
(972) 869-3789
Entity
Organization
Contact information
Practice address
984 FIRST COLONIAL RD STE 300, VIRGINIA BEACH, VA 23454-3196
(757) 412-0235
(757) 381-7123
Mailing address
984 FIRST COLONIAL RD STE 300, VIRGINIA BEACH, VA 23454-3196
(757) 412-0235
(757) 381-7123
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
—
—
Other
Enumeration date
07/25/2025
Last updated
07/25/2025
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