Provider Demographics
NPI:1902242019
Name:GANTES, BERNARD GEORGES (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:BERNARD
Middle Name:GEORGES
Last Name:GANTES
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 1:2999 WESTMINSTER, SUITE 108
Mailing Address - Street 2:
Mailing Address - City:SEAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90740
Mailing Address - Country:US
Mailing Address - Phone:562-431-9739
Mailing Address - Fax:562-683-0474
Practice Address - Street 1:2999 WESTMINSTER, SUITE 108
Practice Address - Street 2:
Practice Address - City:SEAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:90740
Practice Address - Country:US
Practice Address - Phone:562-431-9739
Practice Address - Fax:562-683-0474
Is Sole Proprietor?:No
Enumeration Date:2013-05-15
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0323051223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics