Healthcare Provider Details

I. General information

NPI: 1639365513
Provider Name (Legal Business Name): ANKE BEYER-JORDAN D.D.S., PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DR. ANKE BEYER-JORDAN

II. Dates (important events)

Enumeration Date: 09/24/2007
Last Update Date: 10/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13859 CARMEL VALLEY RD STE D
SAN DIEGO CA
92130-5665
US

IV. Provider business mailing address

8895 PIPESTONE WAY SAN DIEGO
SAN DIEGO CA
92129-2946
US

V. Phone/Fax

Practice location:
  • Phone: 858-484-9090
  • Fax:
Mailing address:
  • Phone: 858-401-9717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number52040
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: