Healthcare Provider Details

I. General information

NPI: 1881670412
Provider Name (Legal Business Name): JEFFREY GERALD ANT DDS,MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2005
Last Update Date: 10/10/2023
Certification Date: 10/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11866 CYPRESS CANYON RD UNIT #2
SAN DIEGO CA
92131-5707
US

IV. Provider business mailing address

11866 CYPRESS CANYON RD UNIT #2
SAN DIEGO CA
92131-5707
US

V. Phone/Fax

Practice location:
  • Phone: 858-603-5491
  • Fax:
Mailing address:
  • Phone: 858-603-5491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number7762
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: