Provider Demographics
NPI:1780845438
Name:JEANBART, ANDRE (DDS)
Entity type:Individual
Prefix:DR
First Name:ANDRE
Middle Name:
Last Name:JEANBART
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 1:860 HAMPSHIRE RD
Mailing Address - Street 2:SUITE M
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-2803
Mailing Address - Country:US
Mailing Address - Phone:805-497-7666
Mailing Address - Fax:805-497-4483
Practice Address - Street 1:860 HAMPSHIRE RD
Practice Address - Street 2:SUITE M
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-2803
Practice Address - Country:US
Practice Address - Phone:805-497-7666
Practice Address - Fax:805-497-4483
Is Sole Proprietor?:No
Enumeration Date:2008-06-24
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA526141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice