Provider Demographics
NPI:1578733895
Name:CANTWELL DENTAL GROUP LTD
Entity Type:Organization
Organization Name:CANTWELL DENTAL GROUP LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:M
Authorized Official - Last Name:MYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-509-7111
Mailing Address - Street 1:2207 OREGON PIKE STE 101
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-4669
Mailing Address - Country:US
Mailing Address - Phone:717-509-7111
Mailing Address - Fax:717-509-8527
Practice Address - Street 1:2207 OREGON PIKE STE 101
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-4669
Practice Address - Country:US
Practice Address - Phone:717-509-7111
Practice Address - Fax:717-509-8527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-03
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADSO31346L1223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty