Individual
DR. MATHEW KAVANAUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
2828 E STATE BLVD, SUITE B, FORT WAYNE, IN 46805-4761
(260) 482-6689
(260) 482-6948
Mailing address
2828 E STATE BLVD, SUITE B, FORT WAYNE, IN 46805-4761
(260) 482-6689
(260) 482-6948
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
12010783A
IN
Other
Enumeration date
04/17/2007
Last updated
07/08/2007
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