NPIMap

Individual provider Active NPI

Robert Kyle Cavanaugh, D.D.S.

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Valparaiso, IN
National Provider Identifier
1790793313
Registry record updated Jul 23, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X
License
12010044A Issued in IN
Practice address
800 Wall St
Suite a
Valparaiso, IN 46383-2564
Phone
(219) 476-4110
Fax
(219) 476-2042
NPI assigned
Aug 3, 2006
Sex
Male
Sole proprietor
No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
12010044AINMDOrthodontics and Dentofacial Orthopedic Dentist

Practice roles

OrganizationSpecialtyStatusNew patients
Cavanaugh Orthodontics PC Orthodontics and Dentofacial Orthopedics Past Accepting new patients

NPPES NPI Registry

Updated by the provider on Jul 23, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthodontics and Dentofacial Orthopedics Dentistry 1223X0400X 12010044A IN Primary

Addresses

Primary practice location

800 Wall St
Suite a
Valparaiso, IN 46383-2564

Mailing address

800 Wall St
Suite a
Valparaiso, IN 46383-2564
Phone (219) 476-4110

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jul 23, 2010.

{
    "created_epoch": "1154563200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1279843200000",
    "number": "1790793313",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 WALL ST",
            "address_2": "SUITE A",
            "city": "VALPARAISO",
            "state": "IN",
            "postal_code": "463832564",
            "telephone_number": "219-476-4110",
            "fax_number": "219-476-9042"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 WALL ST",
            "address_2": "SUITE A",
            "city": "VALPARAISO",
            "state": "IN",
            "postal_code": "463832564",
            "telephone_number": "219-476-4110",
            "fax_number": "219-476-2042"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CAVANAUGH",
        "first_name": "ROBERT",
        "middle_name": "KYLE",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-03",
        "last_updated": "2010-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "IN",
            "license": "12010044A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Valparaiso, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.