Healthcare Provider Details

I. General information

NPI: 1619123627
Provider Name (Legal Business Name): ANTEMIO MILLOT D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2008
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3075 FIRESTONE BLVD
SOUTH GATE CA
90280-2739
US

IV. Provider business mailing address

3075 FIRESTONE BLVD
SOUTH GATE CA
90280-2739
US

V. Phone/Fax

Practice location:
  • Phone: 323-567-2530
  • Fax: 310-388-1088
Mailing address:
  • Phone: 323-567-2530
  • Fax: 310-388-1088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number57202
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: