Provider Demographics
NPI:1275685315
Name:KUPRIONAS, ANTHONY D (DDS)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:D
Last Name:KUPRIONAS
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 1:1073 OAK ST
Mailing Address - Street 2:
Mailing Address - City:PITTSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18640-3716
Mailing Address - Country:US
Mailing Address - Phone:570-654-4141
Mailing Address - Fax:570-654-2150
Practice Address - Street 1:1073 OAK ST
Practice Address - Street 2:
Practice Address - City:PITTSTON
Practice Address - State:PA
Practice Address - Zip Code:18640-3716
Practice Address - Country:US
Practice Address - Phone:570-654-4141
Practice Address - Fax:570-654-2150
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS019157L1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0005246090002Medicaid