Provider Demographics
NPI:1942354824
Name:CANTOR, JEFFREY S (DDS)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:S
Last Name:CANTOR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 PINE ST
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-4853
Mailing Address - Country:US
Mailing Address - Phone:847-707-5594
Mailing Address - Fax:708-478-8293
Practice Address - Street 1:927 S MANNHEIM RD
Practice Address - Street 2:
Practice Address - City:WESTCHESTER
Practice Address - State:IL
Practice Address - Zip Code:60154-2565
Practice Address - Country:US
Practice Address - Phone:705-349-1818
Practice Address - Fax:708-478-8293
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1915108122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist