Provider Demographics
NPI:1821375072
Name:ANTHONY FERRERA DDS LLC
Entity Type:Organization
Organization Name:ANTHONY FERRERA DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:W
Authorized Official - Last Name:FERRERA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:650-697-4999
Mailing Address - Street 1:1740 MARCO POLO WAY
Mailing Address - Street 2:SUITE #12
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-4522
Mailing Address - Country:US
Mailing Address - Phone:650-697-4999
Mailing Address - Fax:650-697-7625
Practice Address - Street 1:1740 MARCO POLO WAY
Practice Address - Street 2:SUITE #12
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-4522
Practice Address - Country:US
Practice Address - Phone:650-697-4999
Practice Address - Fax:650-697-7625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-15
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57429332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6598950001OtherDME PTAN
FI115AOtherPTAN