Provider Demographics
NPI:1558808717
Name:KANTOR DENTAL GROUP PLLC
Entity Type:Organization
Organization Name:KANTOR DENTAL GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:KANTOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-964-1123
Mailing Address - Street 1:41927 PACIFIC GROVE WAY
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-7923
Mailing Address - Country:US
Mailing Address - Phone:317-964-1123
Mailing Address - Fax:
Practice Address - Street 1:4760 W MINERAL AVE
Practice Address - Street 2:SUITE 60
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80128-2532
Practice Address - Country:US
Practice Address - Phone:317-964-1123
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-26
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00202941122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty