Individual
DR. DENISE M ANTALIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
1500 DEERPATH DRIVE, CAMBRIDGE, OH 43725-1143
(740) 439-2501
(740) 439-2240
Mailing address
1500 DEERPATH DRIVE, CAMBRIDGE, OH 43725-1143
(740) 439-2501
(740) 439-2240
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
19405
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
311450774
TAX IDENTICATION NUMBER
OH
Enumeration date
07/13/2006
Last updated
08/18/2008
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