Provider Demographics
NPI:1275543142
Name:SCHANTZ, JEFFREY R (DDS, M DENT SC)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:R
Last Name:SCHANTZ
Suffix:
Gender:M
Credentials:DDS, M DENT SC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73211 FRED WARING DR STE 201
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260-2871
Mailing Address - Country:US
Mailing Address - Phone:760-568-5987
Mailing Address - Fax:760-776-1826
Practice Address - Street 1:73211 FRED WARING DR STE 201
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-2871
Practice Address - Country:US
Practice Address - Phone:760-568-5987
Practice Address - Fax:760-776-1826
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA267011223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA821955OtherUNITED CONCORDIA