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General NPI Number Information
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NPI Number | 1558808717
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Entity Type | Organization
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Legal Business Name | KANTOR DENTAL GROUP PLLC
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Dates
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Enumeration Date | 01/26/2017
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Last Update Date | 01/26/2017
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Provider Practice Location Address
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Address Line | 4760 W MINERAL AVE SUITE 60
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City | LITTLETON
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State | CO
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Zip | 80128-2532
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Country | US
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Telephone | 317-964-1123
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Fax |
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Provider Business Mailing Address
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Address Line | 41927 PACIFIC GROVE WAY
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City | TEMECULA
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State | CA
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Zip | 92591-7923
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Country | US
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Telephone | 317-964-1123
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ALEXANDRA KANTOR
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Credential |
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Telephone | 317-964-1123
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 00202941
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License Number State | CO
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