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General NPI Number Information
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NPI Number | 1518881598
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Entity Type | Individual
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Provider Name | ELENA GRACE CANTWELL
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Gender | Female
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Dates
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Enumeration Date | 08/04/2026
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Last Update Date | 08/04/2026
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Provider Practice Location Address
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Address Line | 1650 COCHRANE CIR UNIT MEDDAC
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City | FORT CARSON
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State | CO
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Zip | 80913-4604
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Country | US
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Telephone | 719-526-7000
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Fax |
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Provider Business Mailing Address
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Address Line | 2213 W BIJOU ST
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City | COLORADO SPRINGS
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State | CO
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Zip | 80904-3443
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Country | US
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Telephone | 434-218-9788
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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 | 0401420036
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License Number State | VA
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