Provider Demographics
NPI:1750506085
Name:DITCHARO, ANTHONY WADE (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:WADE
Last Name:DITCHARO
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 1:1574 MEDICAL CENTER PKWY STE 201
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129-3762
Mailing Address - Country:US
Mailing Address - Phone:615-297-6997
Mailing Address - Fax:615-895-9035
Practice Address - Street 1:1574 MEDICAL CENTER PKWY STE 201
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-3762
Practice Address - Country:US
Practice Address - Phone:615-297-6997
Practice Address - Fax:615-895-9035
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS329104122300000X
TN9105122300000X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist