Provider Demographics
NPI:1033100599
Name:ROBERT M. WAXLER, D.M.D.,M.S.,JEFFERY T. CAVANAUGH, D.D.S.,P.C.
Entity Type:Organization
Organization Name:ROBERT M. WAXLER, D.M.D.,M.S.,JEFFERY T. CAVANAUGH, D.D.S.,P.C.
Other - Org Name:CENTURY ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:WAXLER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:636-391-0499
Mailing Address - Street 1:410 SOVEREIGN CT
Mailing Address - Street 2:STE 19
Mailing Address - City:MANCHESTER
Mailing Address - State:MO
Mailing Address - Zip Code:63011-4400
Mailing Address - Country:US
Mailing Address - Phone:636-391-0499
Mailing Address - Fax:636-391-7340
Practice Address - Street 1:410 SOVEREIGN CT
Practice Address - Street 2:STE 19
Practice Address - City:MANCHESTER
Practice Address - State:MO
Practice Address - Zip Code:63011-4400
Practice Address - Country:US
Practice Address - Phone:636-391-0499
Practice Address - Fax:636-391-7340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO123366531223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty