Provider Demographics
NPI:1801099882
Name:VISCONTI, ANTHONY JOSEPH III (DMD)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:JOSEPH
Last Name:VISCONTI
Suffix:III
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 1:333 EAST NEW YORK AVE.
Mailing Address - Street 2:SUITE B
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32724
Mailing Address - Country:US
Mailing Address - Phone:386-734-7330
Mailing Address - Fax:386-734-0329
Practice Address - Street 1:333 E NEW YORK AVE
Practice Address - Street 2:SUITE B
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32724-5562
Practice Address - Country:US
Practice Address - Phone:386-734-7330
Practice Address - Fax:386-734-0329
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN-14130122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist