Provider Demographics
NPI:1134383532
Name:PONZIO, ANTHONY ORLANDO (DDS)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:ORLANDO
Last Name:PONZIO
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 1:7518 W NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:ELMWOOD PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60707-4140
Mailing Address - Country:US
Mailing Address - Phone:708-452-8100
Mailing Address - Fax:708-453-7988
Practice Address - Street 1:7518 W NORTH AVE
Practice Address - Street 2:
Practice Address - City:ELMWOOD PARK
Practice Address - State:IL
Practice Address - Zip Code:60707-4140
Practice Address - Country:US
Practice Address - Phone:708-452-8100
Practice Address - Fax:708-453-7988
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-15
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190263901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice