Provider Demographics
NPI:1265569560
Name:CANTU, IRMA IRENE (DDS)
Entity type:Individual
Prefix:
First Name:IRMA
Middle Name:IRENE
Last Name:CANTU
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 1:5460 BABCOCK RD STE 105
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-3400
Mailing Address - Country:US
Mailing Address - Phone:210-694-4999
Mailing Address - Fax:210-923-2974
Practice Address - Street 1:5460 BABCOCK RD STE 105
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-3400
Practice Address - Country:US
Practice Address - Phone:210-694-4999
Practice Address - Fax:210-923-2974
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX180541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX975778OtherUNITED CONCORDIA ID
TX1D8054OtherBCBS LOCATION 2
TXD18054OtherBCBS PRIMARY LOCATION
TX009377501Medicaid