=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427128438
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DOMINIC S CANNATTI
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/08/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 713 CAPITAL AVE SW
-----------------------------------------------------
City | BATTLE CREEK
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49015
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 269-963-8519
-----------------------------------------------------
Fax | 269-963-0219
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 713 CAPITAL AVE SW
-----------------------------------------------------
City | BATTLE CREEK
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49015
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 269-963-8519
-----------------------------------------------------
Fax | 269-963-0219
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. DOMINIC S CANNATTI
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 269-963-8519
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 06042
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------