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General NPI Number Information
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NPI Number | 1942354824
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Entity Type | Individual
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Provider Name | JEFFREY S CANTOR D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 01/22/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 927 S MANNHEIM RD
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City | WESTCHESTER
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State | IL
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Zip | 60154-2565
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Country | US
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Telephone | 705-349-1818
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Fax | 708-478-8293
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Provider Business Mailing Address
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Address Line | 209 PINE ST
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City | DEERFIELD
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State | IL
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Zip | 60015-4853
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Country | US
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Telephone | 847-707-5594
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Fax | 708-478-8293
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 1915108
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License Number State | IL
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