Provider Demographics
NPI:1912762535
Name:PAYTON CANCHOLA DDS PA
Entity Type:Organization
Organization Name:PAYTON CANCHOLA DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TANIA
Authorized Official - Middle Name:
Authorized Official - Last Name:IMPASTATO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:128-183-2227
Mailing Address - Street 1:94 W GRAND PKWY S STE 240
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-7049
Mailing Address - Country:US
Mailing Address - Phone:281-832-2278
Mailing Address - Fax:
Practice Address - Street 1:94 W GRAND PKWY S STE 240
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-7049
Practice Address - Country:US
Practice Address - Phone:281-832-2278
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-14
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty