Provider Demographics
NPI:1821351784
Name:ANTHONY J. DESTEFANO, DMD, PA
Entity Type:Organization
Organization Name:ANTHONY J. DESTEFANO, DMD, PA
Other - Org Name:BITE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:JASON
Authorized Official - Last Name:DESTEFANO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:919-723-7461
Mailing Address - Street 1:6101 GRACE PARK DR
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-6003
Mailing Address - Country:US
Mailing Address - Phone:919-571-2484
Mailing Address - Fax:919-571-2486
Practice Address - Street 1:6101 GRACE PARK DR
Practice Address - Street 2:
Practice Address - City:MORRISVILLE
Practice Address - State:NC
Practice Address - Zip Code:27560-6003
Practice Address - Country:US
Practice Address - Phone:919-571-2484
Practice Address - Fax:919-571-2486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-15
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC86921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty