Provider Demographics
NPI:1184756181
Name:CAVITT, MARY ROSE (DDS)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:ROSE
Last Name:CAVITT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 PLAINFIELD ROAD
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435
Mailing Address - Country:US
Mailing Address - Phone:815-727-9903
Mailing Address - Fax:915-727-2133
Practice Address - Street 1:BEST IMAGE DENTAL
Practice Address - Street 2:625 PLAINFIELD ROAD
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435
Practice Address - Country:US
Practice Address - Phone:815-727-9903
Practice Address - Fax:815-727-2133
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist