Healthcare Provider Details

I. General information

NPI: 1881328979
Provider Name (Legal Business Name): ARLENE CANCHOLA DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2022
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2233 COUNTY ROAD 210 W
ST JOHNS FL
32259-4019
US

IV. Provider business mailing address

3655 MESA TOP DR
MONUMENT CO
80132-7968
US

V. Phone/Fax

Practice location:
  • Phone: 904-560-6746
  • Fax:
Mailing address:
  • Phone: 562-501-8791
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number00205147
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN31441
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number107623
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: