Provider Demographics
NPI:1609281427
Name:CAVANAUGH, CATHERINE (DMD)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:CAVANAUGH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 W BALTIMORE PIKE
Mailing Address - Street 2:SUITE 12
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-5540
Mailing Address - Country:US
Mailing Address - Phone:610-566-0885
Mailing Address - Fax:610-566-0741
Practice Address - Street 1:1215 W BALTIMORE PIKE
Practice Address - Street 2:SUITE 12
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-5540
Practice Address - Country:US
Practice Address - Phone:610-566-0885
Practice Address - Fax:610-566-0741
Is Sole Proprietor?:No
Enumeration Date:2014-07-01
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0350821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice