Provider Demographics
NPI:1750468443
Name:BACCHI, ANTHONY J (DDS)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:J
Last Name:BACCHI
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 1:3366 PARK AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WANTAGH
Mailing Address - State:NY
Mailing Address - Zip Code:11793-3773
Mailing Address - Country:US
Mailing Address - Phone:516-785-2255
Mailing Address - Fax:
Practice Address - Street 1:3366 PARK AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:WANTAGH
Practice Address - State:NY
Practice Address - Zip Code:11793-3773
Practice Address - Country:US
Practice Address - Phone:516-785-2255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046454-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY046454OtherNY STATE REGISTRATION
NY046454OtherNY STATE REGISTRATION