Provider Demographics
NPI:1558553768
Name:IPPOLITO, ANTHONY JAMES (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:JAMES
Last Name:IPPOLITO
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 1:9315 MARTIN RD
Mailing Address - Street 2:
Mailing Address - City:CLARENCE CTR
Mailing Address - State:NY
Mailing Address - Zip Code:14032-9302
Mailing Address - Country:US
Mailing Address - Phone:716-863-1533
Mailing Address - Fax:
Practice Address - Street 1:9315 MARTIN RD
Practice Address - Street 2:
Practice Address - City:CLARENCE CTR
Practice Address - State:NY
Practice Address - Zip Code:14032-9302
Practice Address - Country:US
Practice Address - Phone:716-863-1533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-11
Last Update Date:2007-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0485641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice