Healthcare Provider Details

I. General information

NPI: 1760510499
Provider Name (Legal Business Name): TERESA PEREZ CAVNAUGH DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 01/27/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1028 EDGEWATER CORPORATE PKWY
INDIAN LAND SC
29707-0107
US

IV. Provider business mailing address

1604 CHURCHILL DOWNS DR
WAXHAW NC
28173
US

V. Phone/Fax

Practice location:
  • Phone: 803-835-2500
  • Fax:
Mailing address:
  • Phone: 630-391-1026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019.025077
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number10444
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number7119
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: