Provider Demographics
NPI:1720292998
Name:GAROFALO, ANTHONY PHILIP (DMD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:PHILIP
Last Name:GAROFALO
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 1:742 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92021-4630
Mailing Address - Country:US
Mailing Address - Phone:619-440-0071
Mailing Address - Fax:619-440-0719
Practice Address - Street 1:742 BROADWAY
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92021-4630
Practice Address - Country:US
Practice Address - Phone:619-440-0071
Practice Address - Fax:619-440-0719
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA257091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice