Provider Demographics
NPI:1265849095
Name:CANTU PEDIATRIC DENTISTRY PLLC
Entity Type:Organization
Organization Name:CANTU PEDIATRIC DENTISTRY PLLC
Other - Org Name:PEDIATRIC DENTISTRY OF SAN ANTONIO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DERRICK
Authorized Official - Middle Name:EMERY
Authorized Official - Last Name:CANTU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:210-680-7841
Mailing Address - Street 1:6756 POSS RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78238-2258
Mailing Address - Country:US
Mailing Address - Phone:210-680-7841
Mailing Address - Fax:210-680-3503
Practice Address - Street 1:6756 POSS RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78238-2258
Practice Address - Country:US
Practice Address - Phone:210-680-7841
Practice Address - Fax:210-680-3503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-14
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty