=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639365513
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANKE BEYER-JORDAN D.D.S., PH.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/24/2007
-----------------------------------------------------
Last Update Date | 10/25/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13859 CARMEL VALLEY RD STE D
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92130-5665
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 858-484-9090
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8895 PIPESTONE WAY SAN DIEGO
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92129-2946
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 858-401-9717
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number | 52040
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------