Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 25654 | TX |
Y | 213EG0000X | General Practice | 25654 | TX |
N | 1223S0112X | Oral and Maxillofacial Surgeon | 25654 | CA |
NPI | 1013226240 |
---|---|
Provider Name | Mr. Daniel Cantu |
First Address | Edingburg, TX 78539 |
Second Address | Edingburg, TX 78539 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2010 |
Last Update Date | 05/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2159501-03 | (05) | TX |