Provider Demographics
NPI:1851607766
Name:ANTONY, ARCHANA (DDS)
Entity Type:Individual
Prefix:DR
First Name:ARCHANA
Middle Name:
Last Name:ANTONY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 5TH ST NW
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33881-4672
Mailing Address - Country:US
Mailing Address - Phone:863-291-5110
Mailing Address - Fax:863-291-5128
Practice Address - Street 1:201 MAGNOLIA AVE SW
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-2943
Practice Address - Country:US
Practice Address - Phone:863-291-5110
Practice Address - Fax:863-291-5128
Is Sole Proprietor?:No
Enumeration Date:2010-08-30
Last Update Date:2016-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHAD 80122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist