Provider Demographics
NPI:1649380577
Name:KANTRALES, PETER D (DDS)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:D
Last Name:KANTRALES
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:PETER
Other - Middle Name:DANIEL
Other - Last Name:KANTRALES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:4400 BAYOU BLVD BLDG 3A
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503
Mailing Address - Country:US
Mailing Address - Phone:850-478-4260
Mailing Address - Fax:850-478-4618
Practice Address - Street 1:4400 BAYOU BLVD BLDG 3A
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503
Practice Address - Country:US
Practice Address - Phone:850-478-4260
Practice Address - Fax:850-478-4618
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6410122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist