Provider Demographics
NPI:1639365513
Name:BEYER-JORDAN, ANKE (DDS, PHD)
Entity Type:Individual
Prefix:DR
First Name:ANKE
Middle Name:
Last Name:BEYER-JORDAN
Suffix:
Gender:F
Credentials:DDS, PHD
Other - Prefix:DR
Other - First Name:ANKE
Other - Middle Name:
Other - Last Name:BEYER-JORDAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8895 PIPESTONE WAY
Mailing Address - Street 2:SAN DIEGO
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129-2946
Mailing Address - Country:US
Mailing Address - Phone:858-401-9717
Mailing Address - Fax:
Practice Address - Street 1:13859 CARMEL VALLEY RD STE D
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-5665
Practice Address - Country:US
Practice Address - Phone:858-484-9090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-24
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA520401223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics