Kenneth J Cavallari, DDS

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

0401007923 Issued in VA

Practice address

984 First Colonial Rd
Suite 300
Virginia Beach, VA 23454

Phone

(757) 412-0235

Fax

(757) 381-7123

NPI assigned

Jun 18, 2008

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Kenneth J. Cavallari, DDS, PC

  dba Tidewater Laser Perio & Implants

  • Periodontics
  • Virginia Beach, VA
  • NPI 1164305421
  NPD
• East Carolina Anesthesia Associates, PLLC

  • Anesthesiology Physician
  • Greenville, NC
  • NPI 1205996519
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1213747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1758067200000",
    "number": "1033370598",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "984 FIRST COLONIAL RD",
            "address_2": "SUITE 300",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "23454",
            "telephone_number": "757-412-0235",
            "fax_number": "757-496-6695"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "984 FIRST COLONIAL RD",
            "address_2": "SUITE 300",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "23454",
            "telephone_number": "757-412-0235",
            "fax_number": "757-381-7123"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CAVALLARI",
        "first_name": "KENNETH",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-06-18",
        "last_updated": "2025-09-17",
        "certification_date": "2025-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "VA",
            "license": "0401007923",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nikki Catinazzo
• Robert Boyd Beau Caulder, AGPCNP-C
• Causal Centre for Natural Medicine
• Ashley Martin Causey, CCC-SLP
• Cavalier Chiropractic
• Anthony Joseph Cavallo, D.P.M.
• Caitlin Cavanaugh
• Kara Marie Cavanaugh, PA-C
• Cavany Therapy, PLLC
• Danielle Diorio Cavey

• Periodontics in Virginia Beach, VA
• Providers in Virginia Beach, VA by specialty
• Periodontics in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.