Provider Demographics
NPI:1548310170
Name:KANTNER, JOSEPH F (DMD FAGD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:F
Last Name:KANTNER
Suffix:
Gender:M
Credentials:DMD FAGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 NORTH PROVIDENCE ROAD
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063
Mailing Address - Country:US
Mailing Address - Phone:610-565-0525
Mailing Address - Fax:610-565-4724
Practice Address - Street 1:511 NORTH PROVIDENCE ROAD
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063
Practice Address - Country:US
Practice Address - Phone:610-565-0525
Practice Address - Fax:610-565-4724
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS025885L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist