Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 2385 | ND |
N | 1223D0001X | Dental Public Health | 2385 | ND |
N | 1223G0001X | General Practice | 2385 | ND |
N | 213EG0000X | General Practice | 2385 | ND |
NPI | 1144874108 |
---|---|
Provider Name | Sarah Ruth Cavanaugh |
First Address | Saint Michael, ND 58370-0023 |
Second Address | Fort Totten, ND 58335 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2019 |
Last Update Date | 29/07/2019 |