MEDICARE: C.D. CANTU D.D.S. INC

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	9433	TX

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	:	1891944336
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	C.D. CANTU D.D.S. INC

Provider Business Mailing Address
First Line	:	7444 HARRISBURG BLVD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77011-4741
Country	:	US
Telephone Number	:	713-926-5144
Fax Number	:	713-926-5235

Provider Business Practice Location Address
First Line	:	7444 HARRISBURG BLVD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77011-4741
Country	:	US
Telephone Number	:	713-926-5144
Fax Number	:	713-926-5235

Authorized Official
Title or Position	:	GENERAL PRACTICE DENTIST
Name	:	DR. CHRISTOPHER DONALD CANTU
Credential	:	D.D.S.
Telephone Number	:	713-926-5144

Provider Enumeration Date	:	09/09/2008
Last Update Date	:	09/09/2008

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