Provider Demographics
NPI:1265565196
Name:ANISZ, ANTONIO R (DDS)
Entity type:Individual
Prefix:DR
First Name:ANTONIO
Middle Name:R
Last Name:ANISZ
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 1:2150 TAMIAMI TRL UNIT 19
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33948-3106
Mailing Address - Country:US
Mailing Address - Phone:941-627-6300
Mailing Address - Fax:941-627-6319
Practice Address - Street 1:2150 TAMIAMI TRL UNIT 19
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33948-3106
Practice Address - Country:US
Practice Address - Phone:941-627-6300
Practice Address - Fax:941-627-6319
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL93981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAA2020460OtherDEA #