Provider Demographics
NPI:1679026439
Name:CALASCIBETTA, ANTONIO (DDS)
Entity Type:Individual
Prefix:
First Name:ANTONIO
Middle Name:
Last Name:CALASCIBETTA
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 1:70 STABLEGATE DR
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580-9382
Mailing Address - Country:US
Mailing Address - Phone:585-355-2141
Mailing Address - Fax:
Practice Address - Street 1:2615 CULVER RD STE 200
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14609-1716
Practice Address - Country:US
Practice Address - Phone:585-467-2745
Practice Address - Fax:585-467-5683
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-28
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY059344332B00000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies