Provider Demographics
NPI:1144308594
Name:CANTWELL, DENNIS ROBERT
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:ROBERT
Last Name:CANTWELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7006 LITTLE RIVER TPKE STE A
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-3218
Mailing Address - Country:US
Mailing Address - Phone:703-941-3937
Mailing Address - Fax:703-941-4003
Practice Address - Street 1:7006 LITTLE RIVER TPKE STE A
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-3218
Practice Address - Country:US
Practice Address - Phone:703-941-3937
Practice Address - Fax:703-941-4003
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000023152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist