Provider Demographics
NPI:1447682547
Name:SARAH CANTRELL DDS PLLC
Entity type:Organization
Organization Name:SARAH CANTRELL DDS PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CANTRELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-442-9139
Mailing Address - Street 1:456 COUNTRY CLUB RD
Mailing Address - Street 2:104
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098
Mailing Address - Country:US
Mailing Address - Phone:972-442-9139
Mailing Address - Fax:972-442-9061
Practice Address - Street 1:465 COUNTRY CLUB RD
Practice Address - Street 2:104
Practice Address - City:WYLIE
Practice Address - State:TX
Practice Address - Zip Code:75098-7136
Practice Address - Country:US
Practice Address - Phone:972-442-9139
Practice Address - Fax:972-442-9061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-31
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX28065261QD0000X
TX23948261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1114187895OtherINDIVIDUAL NPI- SARAH CANTRELL DDS
TX1538424163OtherINDIVIDUAL NPI- JONATHAN CANTRELL DDS