Provider Demographics
NPI:1093349706
Name:CANTUA DDS, PLLC DBA DENTAL NOOK
Entity type:Organization
Organization Name:CANTUA DDS, PLLC DBA DENTAL NOOK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:CANTUA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:208-360-6719
Mailing Address - Street 1:13492 BASS PRO DR STE 110
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80921-3852
Mailing Address - Country:US
Mailing Address - Phone:719-235-5885
Mailing Address - Fax:
Practice Address - Street 1:13492 BASS PRO DR STE 110
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80921-3852
Practice Address - Country:US
Practice Address - Phone:719-235-5885
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-03
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental