Provider Demographics
NPI:1609876572
Name:CARROCCIA, ANTHONY SCOTT (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:SCOTT
Last Name:CARROCCIA
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 1:2088 LOWES DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-1620
Mailing Address - Country:US
Mailing Address - Phone:931-648-3233
Mailing Address - Fax:931-648-3266
Practice Address - Street 1:2088 LOWES DR
Practice Address - Street 2:SUITE C
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-1620
Practice Address - Country:US
Practice Address - Phone:931-648-3233
Practice Address - Fax:931-648-3266
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN77171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5440029Medicaid
TN9176520OtherDORAL DENTAL