Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 11262 | GA |
NPI | 1003834268 |
---|---|
Provider Name | Dr. Holly R. Cantrell |
First Address | Cornelia, GA 30531-4363 |
Second Address | Cornelia, GA 30531-4363 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2006 |
Last Update Date | 14/01/2009 |