Provider Demographics
NPI:1700011285
Name:FERRERA, ANTHONY WILLIAM (DDS)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:WILLIAM
Last Name:FERRERA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:ANTHONY
Other - Middle Name:
Other - Last Name:FERRERA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:SOLE MBR
Mailing Address - Street 1:341 NORTH SAN MATEO DRIVE
Mailing Address - Street 2:SUITE #1
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401
Mailing Address - Country:US
Mailing Address - Phone:650-697-4999
Mailing Address - Fax:650-348-1922
Practice Address - Street 1:341 NORTH SAN MATEO DRIVE
Practice Address - Street 2:SUITE #1
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401
Practice Address - Country:US
Practice Address - Phone:650-697-4999
Practice Address - Fax:650-348-1922
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-27
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA574291223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFI115AOtherMEDICARE PTAN