Provider Demographics
NPI:1427001569
Name:ANZELMO, JOSEPH (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:
Last Name:ANZELMO
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 1:4001 LAPALCO BLVD
Mailing Address - Street 2:SUITE 10
Mailing Address - City:HARVEY
Mailing Address - State:LA
Mailing Address - Zip Code:70058-2389
Mailing Address - Country:US
Mailing Address - Phone:504-340-0076
Mailing Address - Fax:504-340-0078
Practice Address - Street 1:4001 LAPALCO BLVD
Practice Address - Street 2:SUITE 10
Practice Address - City:HARVEY
Practice Address - State:LA
Practice Address - Zip Code:70058-2389
Practice Address - Country:US
Practice Address - Phone:504-340-0076
Practice Address - Fax:504-340-0078
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA25711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice