Provider Demographics
NPI:1407870231
Name:DIOGUARDI, ANTHONY THOMAS (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:THOMAS
Last Name:DIOGUARDI
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 1:123 YORK ST
Mailing Address - Street 2:SUITE 2J
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-5614
Mailing Address - Country:US
Mailing Address - Phone:203-777-2513
Mailing Address - Fax:
Practice Address - Street 1:123 YORK ST
Practice Address - Street 2:SUITE 2J
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-5614
Practice Address - Country:US
Practice Address - Phone:203-777-2513
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6446122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist