Provider Demographics
NPI:1720103963
Name:CANTRELL, DONALD JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:
Last Name:CANTRELL
Suffix:JR
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 459
Mailing Address - Street 2:
Mailing Address - City:CORNELIA
Mailing Address - State:GA
Mailing Address - Zip Code:30531-0459
Mailing Address - Country:US
Mailing Address - Phone:706-894-1919
Mailing Address - Fax:706-894-1925
Practice Address - Street 1:157 HODGES ST
Practice Address - Street 2:
Practice Address - City:CORNELIA
Practice Address - State:GA
Practice Address - Zip Code:30531-3295
Practice Address - Country:US
Practice Address - Phone:706-894-1919
Practice Address - Fax:706-894-1925
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0129141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice