Provider Demographics
NPI:1760510499
Name:PEREZ CAVNAUGH, TERESA (DDS)
Entity type:Individual
Prefix:DR
First Name:TERESA
Middle Name:
Last Name:PEREZ CAVNAUGH
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 1:1604 CHURCHILL DOWNS DR
Mailing Address - Street 2:
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173
Mailing Address - Country:US
Mailing Address - Phone:630-391-1026
Mailing Address - Fax:
Practice Address - Street 1:1028 EDGEWATER CORPORATE PKWY
Practice Address - Street 2:
Practice Address - City:INDIAN LAND
Practice Address - State:SC
Practice Address - Zip Code:29707-0107
Practice Address - Country:US
Practice Address - Phone:803-835-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0250771223G0001X
NC104441223G0001X
SC7119122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL9182559Medicaid