Provider Demographics
NPI:1780643817
Name:CAVANAGH, ILEANA LARRAURI (DMD)
Entity Type:Individual
Prefix:DR
First Name:ILEANA
Middle Name:LARRAURI
Last Name:CAVANAGH
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 1:20 WHITE RD STE C
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:07702-4039
Mailing Address - Country:US
Mailing Address - Phone:732-741-5300
Mailing Address - Fax:
Practice Address - Street 1:20 WHITE RD STE C
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:NJ
Practice Address - Zip Code:07702-4039
Practice Address - Country:US
Practice Address - Phone:732-741-5300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-18
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI 019097001223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics