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General NPI Number Information
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NPI Number | 1942559224
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Entity Type | Individual
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Provider Name | ANTOINETTE CANCELADA D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 09/03/2012
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Last Update Date | 01/06/2020
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Provider Practice Location Address
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Address Line | 104 S DESMET LN STE 6
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City | SAINT MARYS
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State | KS
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Zip | 66536-9826
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Country | US
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Telephone | 785-321-3455
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 129
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City | SAINT MARYS
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State | KS
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Zip | 66536-0129
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Country | US
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Telephone | 785-321-3455
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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 | 60839
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License Number State | KS
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