Provider Demographics
NPI:1437198249
Name:DIPASQUALE, ANTHONY GERARD (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:GERARD
Last Name:DIPASQUALE
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 1:115 CAPRON TRL
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-1978
Mailing Address - Country:US
Mailing Address - Phone:321-259-5100
Mailing Address - Fax:321-259-3567
Practice Address - Street 1:115 CAPRON TRL
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-1978
Practice Address - Country:US
Practice Address - Phone:321-259-5100
Practice Address - Fax:321-259-3567
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL124481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice