Provider Demographics
NPI:1881328979
Name:CANCHOLA, ARLENE (DMD)
Entity type:Individual
Prefix:DR
First Name:ARLENE
Middle Name:
Last Name:CANCHOLA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3655 MESA TOP DR
Mailing Address - Street 2:
Mailing Address - City:MONUMENT
Mailing Address - State:CO
Mailing Address - Zip Code:80132-7968
Mailing Address - Country:US
Mailing Address - Phone:562-501-8791
Mailing Address - Fax:
Practice Address - Street 1:3655 MESA TOP DR
Practice Address - Street 2:
Practice Address - City:MONUMENT
Practice Address - State:CO
Practice Address - Zip Code:80132-7968
Practice Address - Country:US
Practice Address - Phone:562-501-8791
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-13
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA107623122300000X
CO00205147122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist