Provider Demographics
NPI:1326216144
Name:CANTARERO, OSWALDO GONZALEZ (LD)
Entity Type:Individual
Prefix:
First Name:OSWALDO
Middle Name:GONZALEZ
Last Name:CANTARERO
Suffix:
Gender:M
Credentials:LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 LANCASTER DR NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97305-1223
Mailing Address - Country:US
Mailing Address - Phone:503-370-4313
Mailing Address - Fax:503-375-5737
Practice Address - Street 1:2300 LANCASTER DR NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97305-1223
Practice Address - Country:US
Practice Address - Phone:503-370-4313
Practice Address - Fax:503-375-5737
Is Sole Proprietor?:No
Enumeration Date:2008-02-14
Last Update Date:2010-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDT-DO-10122043122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122400000XDental ProvidersDenturist