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General NPI Number Information
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NPI Number | 1518496793
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Entity Type | Individual
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Provider Name | DEVIN CANTWELL
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Gender | Male
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Dates
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Enumeration Date | 06/09/2017
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Last Update Date | 06/09/2017
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Provider Practice Location Address
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Address Line | 225 EXCHANGE ST STE D
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City | BURLESON
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State | TX
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Zip | 76028-4588
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Country | US
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Telephone | 817-426-9337
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Fax |
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Provider Business Mailing Address
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Address Line | 5211 W PONTIAC DR
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City | GLENDALE
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State | AZ
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Zip | 85308-9325
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Country | US
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Telephone | 801-707-4590
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 33064
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License Number State | TX
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