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General NPI Number Information
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NPI Number | 1588873806
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Entity Type | Organization
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Legal Business Name | CAVANAUGH ORTHODONTICS PC
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Dates
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Enumeration Date | 05/22/2007
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Last Update Date | 08/24/2010
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Provider Practice Location Address
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Address Line | 800 WALL STREET SUITE A
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City | VALPARAISO
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State | IN
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Zip | 46383-2564
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Country | US
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Telephone | 219-476-4110
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Fax | 219-476-9042
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Provider Business Mailing Address
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Address Line | 800 WALL STREET SUITE A
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City | VALPARAISO
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State | IN
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Zip | 46383-2564
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Country | US
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Telephone | 219-476-4110
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Fax | 219-476-9042
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Authorized Official
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Title or Position | ORTHODONTIST
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Name | DR. ROBERT K CAVANAUGH
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Credential | DDS
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Telephone | 219-476-4110
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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 | 12005966A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 12010862A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 12010044A
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License Number State | IN
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