Provider Demographics
NPI:1023799889
Name:ANTILLON, GERMAN ARTURO (DDS)
Entity type:Individual
Prefix:DR
First Name:GERMAN
Middle Name:ARTURO
Last Name:ANTILLON
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 1:2231 E LENITA LN APT R
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-7959
Mailing Address - Country:US
Mailing Address - Phone:909-750-1488
Mailing Address - Fax:
Practice Address - Street 1:2231 E LENITA LN APT R
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-7959
Practice Address - Country:US
Practice Address - Phone:909-750-1488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-26
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA108988122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist