Provider Demographics
NPI:1417970641
Name:DRS. GANTES & SMITH, A PROFESSIONAL DENTAL CORP.
Entity Type:Organization
Organization Name:DRS. GANTES & SMITH, A PROFESSIONAL DENTAL CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:G
Authorized Official - Last Name:GANTES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:562-431-9739
Mailing Address - Street 1:2999 WESTMINSTER AVE STE 108
Mailing Address - Street 2:
Mailing Address - City:SEAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90740-5370
Mailing Address - Country:US
Mailing Address - Phone:562-431-9739
Mailing Address - Fax:562-683-0474
Practice Address - Street 1:2999 WESTMINSTER AVE STE 108
Practice Address - Street 2:
Practice Address - City:SEAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:90740-5370
Practice Address - Country:US
Practice Address - Phone:562-431-9739
Practice Address - Fax:562-683-0474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2012-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty