Provider Demographics
NPI:1619988011
Name:CANTER, JOHN WALTER FITCHETT (DDS)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:WALTER FITCHETT
Last Name:CANTER
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 1:1741A ERICKSON AVENUE
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22801-8555
Mailing Address - Country:US
Mailing Address - Phone:540-433-3747
Mailing Address - Fax:
Practice Address - Street 1:1741A ERICKSON AVENUE
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-8555
Practice Address - Country:US
Practice Address - Phone:540-433-3747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401007473122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist