Provider Demographics
NPI:1730279266
Name:ANTHONY, MICHAEL S (D D S)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:S
Last Name:ANTHONY
Suffix:
Gender:M
Credentials:D D S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 TIPPETT COURT
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SUNBURY
Mailing Address - State:OH
Mailing Address - Zip Code:43074-8572
Mailing Address - Country:US
Mailing Address - Phone:740-965-4090
Mailing Address - Fax:
Practice Address - Street 1:100 TIPPETT CT
Practice Address - Street 2:SUITE 103
Practice Address - City:SUNBURY
Practice Address - State:OH
Practice Address - Zip Code:43074-8572
Practice Address - Country:US
Practice Address - Phone:740-965-4090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH146381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice