Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 23820 | TX |
N | 1223S0112X | Oral and Maxillofacial Surgeon | 23820 | TX |
NPI | 1841439734 |
---|---|
Provider Name | Mr. Vincent John Cavaretta III |
First Address | Austin, TX 78746-6458 |
Second Address | Austin, TX 78746-6458 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/02/2009 |
Last Update Date | 01/12/2009 |