Provider Demographics
NPI:1134183197
Name:MASTROIANNI, ANTHONY JAMES (DDS)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:JAMES
Last Name:MASTROIANNI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 3RD ST
Mailing Address - Street 2:
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14301-1507
Mailing Address - Country:US
Mailing Address - Phone:716-284-0311
Mailing Address - Fax:716-284-2150
Practice Address - Street 1:515 3RD ST
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14301-1507
Practice Address - Country:US
Practice Address - Phone:716-284-0311
Practice Address - Fax:716-284-2150
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-14
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0315821223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00612515Medicaid
NY018291Medicare ID - Type Unspecified
NY00612515Medicaid