Provider Demographics
NPI:1821589581
Name:CANCHOLA, PAYTON (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAYTON
Middle Name:
Last Name:CANCHOLA
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 1:110 HERITAGE TRL
Mailing Address - Street 2:
Mailing Address - City:BELLVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77418-9300
Mailing Address - Country:US
Mailing Address - Phone:979-877-4929
Mailing Address - Fax:
Practice Address - Street 1:94 W GRAND PKWY S STE 240
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-7049
Practice Address - Country:US
Practice Address - Phone:832-990-7757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-29
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX390200000X
390200000X
TX34528122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program