MEDICARE: DR. ANKE BEYER-JORDAN D.D.S., PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	52040	CA

General Provider Information

NPI Number	:	1639365513
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANKE BEYER-JORDAN D.D.S., PH.D.

Provider Business Mailing Address
First Line	:	8895 PIPESTONE WAY
Second Line	:	SAN DIEGO
City	:	SAN DIEGO
State	:	CA
Zip	:	92129-2946
Country	:	US
Telephone Number	:	858-401-9717
Fax Number	:

Provider Business Practice Location Address
First Line	:	13859 CARMEL VALLEY RD STE D
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92130-5665
Country	:	US
Telephone Number	:	858-484-9090
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/24/2007
Last Update Date	:	10/25/2019

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