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General NPI Number Information
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NPI Number | 1447506571
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Entity Type | Organization
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Legal Business Name | GERALD D. CAVANAUGH & WILLIAM F. LILJEMARK
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Dates
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Enumeration Date | 07/26/2012
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Last Update Date | 07/26/2012
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Provider Practice Location Address
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Address Line | 3939 W. 50TH ST SUITE #207
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City | EDINA
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State | MN
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Zip | 55424-1258
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Country | US
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Telephone | 952-926-2335
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Fax | 952-925-0467
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Provider Business Mailing Address
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Address Line | 3939 W. 50TH ST SUITE #207
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City | EDINA
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State | MN
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Zip | 55424-1258
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Country | US
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Telephone | 952-926-2335
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Fax | 952-925-0467
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Authorized Official
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Title or Position | MANAGING PARTNER/ORTHODONTIST
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Name | SCOTT ROBERT BOWLBY
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Credential | D.D.S.
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Telephone | 952-926-2335
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | D11240,9023,10908AND
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License Number State | MN
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