MEDICARE: DR. CAROLYN M. CANTRELL DMD

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	D6877	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508855230
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CAROLYN M. CANTRELL DMD

Provider Business Mailing Address
First Line	:	2233 WILLAMETTE ST
Second Line	:	SUITE B
City	:	EUGENE
State	:	OR
Zip	:	97405-2890
Country	:	US
Telephone Number	:	541-687-2156
Fax Number	:	541-684-9268

Provider Business Practice Location Address
First Line	:	2233 WILLAMETTE ST
Second Line	:	SUITE B
City	:	EUGENE
State	:	OR
Zip	:	97405-2890
Country	:	US
Telephone Number	:	541-687-2156
Fax Number	:	541-684-9268

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

Provider Enumeration Date	:	10/15/2005
Last Update Date	:	07/09/2007

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