Provider Demographics
NPI:1437726718
Name:ANTHONY, SIDNEY NORFLEET IV (DDS)
Entity Type:Individual
Prefix:DR
First Name:SIDNEY
Middle Name:NORFLEET
Last Name:ANTHONY
Suffix:IV
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 1:2630 S WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:RIPLEY
Mailing Address - State:TN
Mailing Address - Zip Code:38063-7865
Mailing Address - Country:US
Mailing Address - Phone:731-612-4341
Mailing Address - Fax:
Practice Address - Street 1:3123 MILLER AVE
Practice Address - Street 2:
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38555-6119
Practice Address - Country:US
Practice Address - Phone:931-484-3664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-07
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN115651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice