Provider Demographics
NPI:1114601622
Name:VASCONEZ, ANTHONY X (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:X
Last Name:VASCONEZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10725 MAGRATH LN
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34654-5888
Mailing Address - Country:US
Mailing Address - Phone:954-728-0507
Mailing Address - Fax:
Practice Address - Street 1:20301 PLEASANT PLAINS PKWY
Practice Address - Street 2:
Practice Address - City:LAND O LAKES
Practice Address - State:FL
Practice Address - Zip Code:34637-6433
Practice Address - Country:US
Practice Address - Phone:813-580-7003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL280751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice