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General NPI Number Information
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NPI Number | 1902242019
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Entity Type | Individual
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Provider Name | BERNARD GEORGES GANTES D.D.S., M.S.
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Gender | Male
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Dates
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Enumeration Date | 05/15/2013
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Last Update Date | 05/15/2013
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Provider Practice Location Address
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Address Line | 2999 WESTMINSTER, SUITE 108
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City | SEAL BEACH
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State | CA
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Zip | 90740
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Country | US
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Telephone | 562-431-9739
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Fax | 562-683-0474
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Provider Business Mailing Address
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Address Line | 2999 WESTMINSTER, SUITE 108
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City | SEAL BEACH
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State | CA
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Zip | 90740
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Country | US
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Telephone | 562-431-9739
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Fax | 562-683-0474
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 032305
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License Number State | CA
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