Provider Demographics
NPI:1003981622
Name:KANTOR, EZRA H (DDS)
Entity Type:Individual
Prefix:DR
First Name:EZRA
Middle Name:H
Last Name:KANTOR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 LAS GALLINAS AVE
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-3432
Mailing Address - Country:US
Mailing Address - Phone:415-492-1616
Mailing Address - Fax:415-492-0466
Practice Address - Street 1:750 LAS GALLINAS AVE
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-3432
Practice Address - Country:US
Practice Address - Phone:415-492-1616
Practice Address - Fax:415-492-0466
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26079122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist