Provider Demographics
NPI:1881670412
Name:ANT, JEFFREY GERALD (DDS,MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:GERALD
Last Name:ANT
Suffix:
Gender:M
Credentials:DDS,MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11866 CYPRESS CANYON RD
Mailing Address - Street 2:UNIT #2
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131-5707
Mailing Address - Country:US
Mailing Address - Phone:858-603-5491
Mailing Address - Fax:
Practice Address - Street 1:11866 CYPRESS CANYON RD
Practice Address - Street 2:UNIT #2
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92131-5707
Practice Address - Country:US
Practice Address - Phone:858-603-5491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA77621223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery