Provider Demographics
NPI:1225144611
Name:CIPRIANO, ANTHONY J (DMD, MPH)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:J
Last Name:CIPRIANO
Suffix:
Gender:M
Credentials:DMD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6100 AVERY DR
Mailing Address - Street 2:APT. #1208
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-3885
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:300 W ROSEDALE ST
Practice Address - Street 2:VA/FWOPC
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4856
Practice Address - Country:US
Practice Address - Phone:817-882-6205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS026505-L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist