Provider Demographics
NPI:1558782748
Name:CANTOR, DARA (LAC)
Entity Type:Individual
Prefix:
First Name:DARA
Middle Name:
Last Name:CANTOR
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11630 SE 40TH AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222
Mailing Address - Country:US
Mailing Address - Phone:503-974-9283
Mailing Address - Fax:503-715-0446
Practice Address - Street 1:11630 SE 40TH AVE
Practice Address - Street 2:SUITE C
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97222-6195
Practice Address - Country:US
Practice Address - Phone:503-974-9283
Practice Address - Fax:503-715-0446
Is Sole Proprietor?:No
Enumeration Date:2013-12-15
Last Update Date:2013-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC165411171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist