Provider Demographics
NPI:1467641159
Name:DEZA, ANTHONY W (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:W
Last Name:DEZA
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 1:26990 KALMIA AVE
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92555-1914
Mailing Address - Country:US
Mailing Address - Phone:951-924-6182
Mailing Address - Fax:951-924-6182
Practice Address - Street 1:2010 N RIVERSIDE AVE
Practice Address - Street 2:SUITE A
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92377-4652
Practice Address - Country:US
Practice Address - Phone:909-421-1555
Practice Address - Fax:909-421-1865
Is Sole Proprietor?:No
Enumeration Date:2007-10-17
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42539122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist