Provider Demographics
NPI:1508474933
Name:CANTRELL, JAMES BRADLEY (DMD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:BRADLEY
Last Name:CANTRELL
Suffix:
Gender:M
Credentials:DMD
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 850
Mailing Address - Street 2:
Mailing Address - City:ROGERSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37857-0850
Mailing Address - Country:US
Mailing Address - Phone:423-921-6975
Mailing Address - Fax:423-921-6920
Practice Address - Street 1:1861 MAIN ST
Practice Address - Street 2:
Practice Address - City:SNEEDVILLE
Practice Address - State:TN
Practice Address - Zip Code:37869-3645
Practice Address - Country:US
Practice Address - Phone:423-733-2131
Practice Address - Fax:423-733-1055
Is Sole Proprietor?:No
Enumeration Date:2020-07-22
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN113291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice