Provider Demographics
NPI:1972800852
Name:BEZERRA, ANTHONY H (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:H
Last Name:BEZERRA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:ANTONIO
Other - Middle Name:HERBETE PAZ
Other - Last Name:BEZERRA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 290370
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33329-0370
Mailing Address - Country:US
Mailing Address - Phone:954-262-4346
Mailing Address - Fax:954-262-2269
Practice Address - Street 1:3200 S UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328-2018
Practice Address - Country:US
Practice Address - Phone:954-262-7369
Practice Address - Fax:954-262-2689
Is Sole Proprietor?:No
Enumeration Date:2011-02-11
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL546122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist