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General NPI Number Information
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NPI Number | 1760510499
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Entity Type | Individual
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Provider Name | TERESA PEREZ CAVNAUGH DDS
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Gender | Female
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Dates
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Enumeration Date | 03/02/2007
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Last Update Date | 01/27/2025
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Provider Practice Location Address
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Address Line | 1028 EDGEWATER CORPORATE PKWY
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City | INDIAN LAND
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State | SC
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Zip | 29707-0107
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Country | US
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Telephone | 803-835-2500
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Fax |
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Provider Business Mailing Address
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Address Line | 1604 CHURCHILL DOWNS DR
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City | WAXHAW
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State | NC
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Zip | 28173
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Country | US
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Telephone | 630-391-1026
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 019.025077
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 10444
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 7119
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License Number State | SC
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