Provider Demographics
NPI:1063631604
Name:CAVANAUGH, MARK PETER (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:PETER
Last Name:CAVANAUGH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 W DRY CREEK CIR STE 125
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80120-8069
Mailing Address - Country:US
Mailing Address - Phone:303-794-6800
Mailing Address - Fax:
Practice Address - Street 1:2 W DRY CREEK CIR STE 125
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-8069
Practice Address - Country:US
Practice Address - Phone:303-794-6800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO55401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice