Provider Demographics
NPI:1477580934
Name:CIANCIMINO, ANTHONY R (DDS)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:R
Last Name:CIANCIMINO
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 1:8202 PENELOPE AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLE VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11379-2337
Mailing Address - Country:US
Mailing Address - Phone:718-326-0003
Mailing Address - Fax:718-326-5269
Practice Address - Street 1:8202 PENELOPE AVE
Practice Address - Street 2:
Practice Address - City:MIDDLE VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11379-2337
Practice Address - Country:US
Practice Address - Phone:718-326-0003
Practice Address - Fax:718-326-5269
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY314331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00976807Medicaid
NY00976807Medicaid