Provider Demographics
NPI:1144533597
Name:CAVKA, AIDA (DMD)
Entity type:Individual
Prefix:DR
First Name:AIDA
Middle Name:
Last Name:CAVKA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:AIDA
Other - Middle Name:CAVKA
Other - Last Name:BASIC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:2511 SAINT JOHNS BLUFF RD S
Mailing Address - Street 2:UNIT 206
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-2346
Mailing Address - Country:US
Mailing Address - Phone:904-329-3371
Mailing Address - Fax:
Practice Address - Street 1:2511 SAINT JOHNS BLUFF RD S
Practice Address - Street 2:UNIT 206
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32246-2346
Practice Address - Country:US
Practice Address - Phone:904-329-3371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-14
Last Update Date:2014-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLD190241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice