Provider Demographics
NPI:1770553406
Name:JOHN, ANTHONY DAVID (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:DAVID
Last Name:JOHN
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10672 WEXFORD ST
Mailing Address - Street 2:SUITE 265
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131-3969
Mailing Address - Country:US
Mailing Address - Phone:858-444-0600
Mailing Address - Fax:
Practice Address - Street 1:10672 WEXFORD ST
Practice Address - Street 2:SUITE 265
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92131-3969
Practice Address - Country:US
Practice Address - Phone:858-444-0600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-25
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA575771223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics