Provider Demographics
NPI:1730195975
Name:CAVANAGH, NORMAN J (DMD, MD)
Entity type:Individual
Prefix:
First Name:NORMAN
Middle Name:J
Last Name:CAVANAGH
Suffix:
Gender:M
Credentials:DMD, MD
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Mailing Address - Street 1:17 TALCOTT NOTCH RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-1818
Mailing Address - Country:US
Mailing Address - Phone:860-524-2626
Mailing Address - Fax:860-677-5029
Practice Address - Street 1:399 FARMINGTON AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-1936
Practice Address - Country:US
Practice Address - Phone:860-548-7338
Practice Address - Fax:860-524-2654
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2011-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT006642204E00000X
CT0349152082S0099X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1730195975Medicaid
CT5037697OtherCIGNA
CT076642OtherCONNECTICARE
CT06-1406459OtherMULTIPLAN
CT06-1406459OtherPIONEER
CT06-1406459OtherTRICARE
CT002066421Medicaid
CT010034915CT01OtherANTHEM BCBS
CT06-1406459OtherFOCUS
CT06-1406459OtherNORTHEAST HEALTH DIRECT
CT06-1406459OtherCORVEL
CT4124672OtherAETNA
CTP3881605OtherOXFORD
CT06-1406459OtherCOMMUNITY HEALTH NETWORK
CT06-1406459OtherUNITED HEALTHCARE
CT06-1406459OtherGREAT-WEST HEALTHCARE
CT06-1406459OtherCOMMUNITY HEALTH NETWORK
CTP3881605OtherOXFORD
CT06-1406459OtherTRICARE