Provider Demographics
NPI:1265596217
Name:BEVACQUI, ANTHONY R (DMD)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:R
Last Name:BEVACQUI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:257 MONMOUTH ROAD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:OAKHURST
Mailing Address - State:NJ
Mailing Address - Zip Code:07755
Mailing Address - Country:US
Mailing Address - Phone:732-531-4165
Mailing Address - Fax:732-531-2610
Practice Address - Street 1:257 MONMOUTH ROAD
Practice Address - Street 2:SUITE 6
Practice Address - City:OAKHURST
Practice Address - State:NJ
Practice Address - Zip Code:07755
Practice Address - Country:US
Practice Address - Phone:732-531-4165
Practice Address - Fax:732-531-2610
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ108231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice