Provider Demographics
NPI:1821118258
Name:CAVANAUGH, PATRICK JOSEPH
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:JOSEPH
Last Name:CAVANAUGH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4585 WASHINGTON ST.
Mailing Address - Street 2:SUITE A-3
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63033-5858
Mailing Address - Country:US
Mailing Address - Phone:314-921-4333
Mailing Address - Fax:314-921-8632
Practice Address - Street 1:4585 WASHINGTON ST
Practice Address - Street 2:SUITE A-3
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63033-5858
Practice Address - Country:US
Practice Address - Phone:314-921-4333
Practice Address - Fax:314-921-8632
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO10992122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist