Provider Demographics
NPI:1710106315
Name:FESTA, ANTONIO (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANTONIO
Middle Name:
Last Name:FESTA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 S MILITARY TRL
Mailing Address - Street 2:STE 4
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33442-3031
Mailing Address - Country:US
Mailing Address - Phone:954-725-3717
Mailing Address - Fax:
Practice Address - Street 1:100 S MILITARY TRL
Practice Address - Street 2:STE 4
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33442-3031
Practice Address - Country:US
Practice Address - Phone:954-725-3717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN0013568122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist