Provider Demographics
NPI:1003106980
Name:BISCONTI, ANTHONY EDWARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:EDWARD
Last Name:BISCONTI
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 1:908 SAHARA TRL
Mailing Address - Street 2:SUITE 1
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44514-3667
Mailing Address - Country:US
Mailing Address - Phone:330-758-0208
Mailing Address - Fax:330-758-2891
Practice Address - Street 1:908 SAHARA TRL
Practice Address - Street 2:SUITE 1
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44514-3667
Practice Address - Country:US
Practice Address - Phone:330-758-0208
Practice Address - Fax:330-758-2891
Is Sole Proprietor?:No
Enumeration Date:2011-04-13
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH192091223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0411665Medicaid