Provider Demographics
NPI:1558486472
Name:PUNTILLO, ANTHONY MYERS (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:MYERS
Last Name:PUNTILLO
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1539 S. COURT STREET
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-4809
Mailing Address - Country:US
Mailing Address - Phone:219-662-2264
Mailing Address - Fax:219-662-2331
Practice Address - Street 1:1539 S. COURT STREET
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-4809
Practice Address - Country:US
Practice Address - Phone:219-662-2264
Practice Address - Fax:219-662-2331
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12009367A1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics