Provider Demographics
NPI:1790901858
Name:NOTTAGE, ANTHONY FRANK III (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:FRANK
Last Name:NOTTAGE
Suffix:III
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3608 N ELM ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27455-2743
Mailing Address - Country:US
Mailing Address - Phone:336-274-3791
Mailing Address - Fax:336-235-2446
Practice Address - Street 1:3608 N ELM ST
Practice Address - Street 2:SUITE B
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27455-2743
Practice Address - Country:US
Practice Address - Phone:336-274-3791
Practice Address - Fax:336-235-2446
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC5938122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC899646-AMedicare UPIN