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General NPI Number Information
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NPI Number | 1679695126
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Entity Type | Organization
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Legal Business Name | HINSDALE DENTAL ASSOCIATES, PC
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Dates
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Enumeration Date | 04/04/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 211 W CHICAGO AVE SUITE 117
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City | HINSDALE
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State | IL
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Zip | 60521-3355
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Country | US
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Telephone | 630-986-5150
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Fax |
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Provider Business Mailing Address
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Address Line | 211 W CHICAGO AVE SUITE 117
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City | HINSDALE
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State | IL
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Zip | 60521-3355
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. TERRENCE M CAVANAUGH
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Credential | D.D.S
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Telephone | 630-986-5150
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State | IL
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