John Richard Kavanagh, D.D.S., M.S.

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

48478 Issued in CA

Practice address

3731 Tibbetts St
Suite 10
Riverside, CA 92506-2604

Phone

(951) 683-4790

Fax

(951) 683-4795

NPI assigned

Oct 17, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Dr. Jack R Kavanagh Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

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

{
    "created_epoch": "1161043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1355270400000",
    "number": "1689755837",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3731 TIBBETTS STREET",
            "address_2": "SUITE 10",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "92606",
            "telephone_number": "951-683-4790",
            "fax_number": "951-683-4795"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3731 TIBBETTS ST",
            "address_2": "SUITE 10",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925062604",
            "telephone_number": "951-683-4790",
            "fax_number": "951-683-4795"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KAVANAGH",
        "first_name": "JOHN",
        "middle_name": "RICHARD",
        "name_prefix": "Dr.",
        "credential": "D.D.S., M.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-17",
        "last_updated": "2012-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "CA",
            "license": "48478",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACK",
            "last_name": "KAVANAGH",
            "middle_name": "R",
            "prefix": "DR.",
            "credential": "D.D.S., M.S.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Manparbodh Kaur
• Pawanjot Kaur
• Subhpaljit Kaur
• Vasudha Kaushik, MD
• Suha Kavak
• Nadia Kavandi, MD
• Rakesh Kavuri
• Jenelle Kay
• Katie T Kay, PHARM.D.
• Michael Stephen Kays

• Orthodontics and Dentofacial Orthopedics Dentistry in Riverside, CA
• Providers in Riverside, CA by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2012; 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.