=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356476428
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHN FRANK ANTON DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/22/2007
-----------------------------------------------------
Last Update Date | 02/10/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1316 JACKIE RD. SUITE 300
-----------------------------------------------------
City | RIO RANCHO
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87124-3741
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-994-9693
-----------------------------------------------------
Fax | 505-891-3169
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1316 JACKIE RD SE SUITE 300
-----------------------------------------------------
City | RIO RANCHO
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87124-6618
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-994-9693
-----------------------------------------------------
Fax | 505-891-3169
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | DD1498
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------