Donald Cantrell Jr., D.M.D.
Individual provider Active NPI General Practice Dentistry · Cornelia, GA
NPI 1720103963 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1720103963
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- DN012914 (GA)
- Practice address
- 157 Hodges St
Cornelia, GA 30531-3295 - Phone
- (706) 894-1919
- Fax
- (706) 894-1925
- NPI assigned
- Mar 20, 2007
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150610002433 | GA | Order and Referring Only - Oral Surgery |
2668793043 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN012914 | GA | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Harrison Macnellis, DMD, LLC | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DN012914 | GA | Yes |
Addresses
Primary practice location
157 Hodges St
Cornelia, GA 30531-3295
Mailing address
PO Box 459
Cornelia, GA 30531-0459
Phone (706) 894-1919
Other providers in Cornelia, GA
- David Dow Black III
- Hayden Black
- Andrew J Brent
- Debra Marie Cain
- Kelly Beth Cain
- Holly R. Cantrell
- Hong-Gil Chae
- Children and Teen Dental Group
- Stephanie Chu
- Hannah Rae Clark
All providers in Cornelia, GA · General Practice Dentistry in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.