Provider Demographics
NPI:1598925281
Name:CANTWELL, NICHOLAS SCOTT (DDS)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:SCOTT
Last Name:CANTWELL
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 1:3441 S 8400 W
Mailing Address - Street 2:SUITE B
Mailing Address - City:MAGNA
Mailing Address - State:UT
Mailing Address - Zip Code:84044-1884
Mailing Address - Country:US
Mailing Address - Phone:801-250-0203
Mailing Address - Fax:801-250-0217
Practice Address - Street 1:3441 S 8400 W
Practice Address - Street 2:SUITE B
Practice Address - City:MAGNA
Practice Address - State:UT
Practice Address - Zip Code:84044-1884
Practice Address - Country:US
Practice Address - Phone:801-250-0203
Practice Address - Fax:801-250-0217
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-16
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7023766-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice