Jared B. Antrobus, DDS
Individual provider Active NPI Oral and Maxillofacial Surgery (Dentist) · Rocklin, CA
NPI 1356540645 · NPPES record last updated Aug 14, 2024
Key facts
- NPI
- 1356540645
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Oral and Maxillofacial Surgery (Dentist) 1223S0112X
- License
- DDS62262 (CA)
- Practice address
- 6000 Fairway Dr Ste 10
Rocklin, CA 95677-4245 - Phone
- (916) 632-5809
- NPI assigned
- Jul 16, 2007
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
- Opted out of Medicare
- Yes, effective Sep 18, 2024 through Sep 18, 2026
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DDS62262 | CA | MD | Oral and Maxillofacial Surgery (Dentist) |
| 62262 | CA | MD | Physician Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Oral and Maxillofacial Surgery (Dentist) | 1223S0112X | DDS62262 | CA | Yes |
Addresses
Primary practice location
6000 Fairway Dr Ste 10
Rocklin, CA 95677-4245
Mailing address
6000 Fairway Dr Ste 10
Rocklin, CA 95677-4245
Phone (916) 632-5809
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| SWMC-258-X | Other | INSTITUTIONAL PERMIT |
Other providers in Rocklin, CA
- Chloe Anderson
- Hermina Andries
- Ryan Andrighetto
- Shanna Reann Angel
- Hermie Lorenzo Remollo Angeles
- Apple Periodontics & Dental Implants
- Nathan Appleby
- Mary Right D Aquino
- Nancy Lee Archibald
- Arena Gade Wilkes Milla McClure Dental Corporation
All providers in Rocklin, CA · Oral and Maxillofacial Surgery (Dentist) in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 14, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Opt Out Affidavits (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.