Individual
ALAN ROY ANTAO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
909 N WASHINGTON ST, BOURBON, IN 46504-1447
(574) 342-4385
Mailing address
3136 WOODFIELD DR, KOKOMO, IN 46902-4788
(765) 513-5700
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
12014150A
IN
122300000X
Dentist
DN21372
FL
363A00000X
Physician Assistant
—
—
Other
Enumeration date
11/17/2010
Last updated
09/25/2024
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