Provider Demographics
NPI:1033138839
Name:CANTWELL, SUSAN DENISE (DDS)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:DENISE
Last Name:CANTWELL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 1/2 EAST MAIN
Mailing Address - Street 2:BOX 1002
Mailing Address - City:HINTON
Mailing Address - State:OK
Mailing Address - Zip Code:73047-1002
Mailing Address - Country:US
Mailing Address - Phone:405-542-3700
Mailing Address - Fax:405-542-3785
Practice Address - Street 1:109 1/2 EAST MAIN
Practice Address - Street 2:BOX 1002
Practice Address - City:HINTON
Practice Address - State:OK
Practice Address - Zip Code:73047-1002
Practice Address - Country:US
Practice Address - Phone:405-542-3700
Practice Address - Fax:405-542-3785
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK50471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice