Provider Demographics
NPI:1760417349
Name:DECARLI, ANTHONY A III (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:A
Last Name:DECARLI
Suffix:III
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 1:119 SOUTH MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ARCHBALD
Mailing Address - State:PA
Mailing Address - Zip Code:18403
Mailing Address - Country:US
Mailing Address - Phone:570-876-6722
Mailing Address - Fax:570-876-5375
Practice Address - Street 1:119 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ARCHBALD
Practice Address - State:PA
Practice Address - Zip Code:18403-1725
Practice Address - Country:US
Practice Address - Phone:570-876-6722
Practice Address - Fax:570-876-5375
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS028582L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice