Provider Demographics
NPI:1639495484
Name:DEFONT, ANTHONY (DDS)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:DEFONT
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 1:641 WOODS CREEK DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-4808
Mailing Address - Country:US
Mailing Address - Phone:209-532-1431
Mailing Address - Fax:
Practice Address - Street 1:641 WOODS CREEK DR
Practice Address - Street 2:SUITE A
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-4808
Practice Address - Country:US
Practice Address - Phone:209-532-1431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-19
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60577122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist