MEDICARE: DR. WILLIE CANTU DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	17063	TX

General Provider Information

NPI Number	:	1023038056
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIE CANTU DDS

Provider Business Mailing Address
First Line	:	13133 NW MILITARY HWY
Second Line	:	STE. 500
City	:	SAN ANTONIO
State	:	TX
Zip	:	78231-1813
Country	:	US
Telephone Number	:	210-479-7500
Fax Number	:	210-479-7585

Provider Business Practice Location Address
First Line	:	13133 NW MILITARY HWY
Second Line	:	STE. 500
City	:	SAN ANTONIO
State	:	TX
Zip	:	78231-1813
Country	:	US
Telephone Number	:	210-479-7500
Fax Number	:	210-479-7585

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	07/08/2007

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