Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 21295 | TX |
NPI | 1104029883 |
---|---|
Provider Name | Dr. Shannon Coyle Cestari |
First Address | Arlington, TX 76012-3149 |
Second Address | Arlington, TX 76012-3149 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2007 |
Last Update Date | 10/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1901290 | (05) | TX |