Provider Demographics
NPI:1346667292
Name:CANTU, WALBERTO (DDS)
Entity Type:Individual
Prefix:DR
First Name:WALBERTO
Middle Name:
Last Name:CANTU
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4001 KENNEDY RD STE 1
Mailing Address - Street 2:
Mailing Address - City:WEST RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99353-7353
Mailing Address - Country:US
Mailing Address - Phone:509-980-0155
Mailing Address - Fax:509-392-8565
Practice Address - Street 1:4001 KENNEDY RD STE 1
Practice Address - Street 2:
Practice Address - City:WEST RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99353-7353
Practice Address - Country:US
Practice Address - Phone:509-980-0155
Practice Address - Fax:509-392-8565
Is Sole Proprietor?:No
Enumeration Date:2014-03-27
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA122300000X122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist