Provider Demographics
NPI:1629969928
Name:GARZON CEBALLOS, JORGE FERNANDO (DDS)
Entity type:Individual
Prefix:
First Name:JORGE
Middle Name:FERNANDO
Last Name:GARZON CEBALLOS
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 1:965 S BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-3983
Mailing Address - Country:US
Mailing Address - Phone:714-527-2982
Mailing Address - Fax:714-386-6496
Practice Address - Street 1:965 S BEACH BLVD
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-3983
Practice Address - Country:US
Practice Address - Phone:714-527-2982
Practice Address - Fax:714-386-6496
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-14
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA111975122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist