Provider Demographics
NPI:1942559224
Name:CANCELADA, ANTOINETTE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANTOINETTE
Middle Name:
Last Name:CANCELADA
Suffix:
Gender:F
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:PO BOX 129
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:KS
Mailing Address - Zip Code:66536-0129
Mailing Address - Country:US
Mailing Address - Phone:785-321-3455
Mailing Address - Fax:
Practice Address - Street 1:104 S DESMET LN STE 6
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:KS
Practice Address - Zip Code:66536-9826
Practice Address - Country:US
Practice Address - Phone:785-321-3455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-03
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS608391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice