Provider Demographics
NPI:1013098045
Name:CAVANAUGH, CATHERINE E (DDS,, MS)
Entity Type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:E
Last Name:CAVANAUGH
Suffix:
Gender:F
Credentials:DDS,, MS
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:714 STEVENS CREEK BLVD
Mailing Address - Street 2:
Mailing Address - City:FORSYTH
Mailing Address - State:IL
Mailing Address - Zip Code:62535-9741
Mailing Address - Country:US
Mailing Address - Phone:217-875-3008
Mailing Address - Fax:
Practice Address - Street 1:391 W WEAVER RD
Practice Address - Street 2:
Practice Address - City:FORSYTH
Practice Address - State:IL
Practice Address - Zip Code:62535-9764
Practice Address - Country:US
Practice Address - Phone:217-872-0623
Practice Address - Fax:217-872-0525
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190231721223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics