| NPI | 1841603313 |
|---|---|
| Former Name | COTY CANTRELL |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: AL 6124) |
| Additional Taxonomies | 122300000X Dentist (Licence: AL 6124) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-06-03 |
| Last Update Date | 2022-07-21 |