Provider Demographics
NPI:1982296240
Name:JENNIFER L. CAVANAUGH, DMD LLC
Entity type:Organization
Organization Name:JENNIFER L. CAVANAUGH, DMD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:L
Authorized Official - Last Name:CAVANAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:412-370-3634
Mailing Address - Street 1:11924 FAIRWAY LAKES DR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33913-8337
Mailing Address - Country:US
Mailing Address - Phone:412-370-3634
Mailing Address - Fax:
Practice Address - Street 1:11924 FAIRWAY LAKES DR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33913-8337
Practice Address - Country:US
Practice Address - Phone:412-370-3634
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-08
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty