Provider Demographics
NPI:1376701995
Name:DELAURETIS, ANTHONY D (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:D
Last Name:DELAURETIS
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 1:3845 GERMANTOWN PIKE
Mailing Address - Street 2:
Mailing Address - City:COLLEGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19426-3163
Mailing Address - Country:US
Mailing Address - Phone:610-454-0911
Mailing Address - Fax:610-454-9661
Practice Address - Street 1:3845 GERMANTOWN PIKE
Practice Address - Street 2:
Practice Address - City:COLLEGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:19426-3163
Practice Address - Country:US
Practice Address - Phone:610-454-0911
Practice Address - Fax:610-454-9661
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-30
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS022501L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist