MEDICARE: ANTHONY A. CIANCIOLO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist

General Provider Information

NPI Number	:	1972754919
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANTHONY A. CIANCIOLO

Provider Business Mailing Address
First Line	:	625 6TH AVE
Second Line	:	FLOOR 1
City	:	DAYTON
State	:	KY
Zip	:	41074-1483
Country	:	US
Telephone Number	:	859-261-0101
Fax Number	:	859-261-0969

Provider Business Practice Location Address
First Line	:	625 6TH AVE
Second Line	:	FLOOR 1
City	:	DAYTON
State	:	KY
Zip	:	41074-1483
Country	:	US
Telephone Number	:	859-261-0101
Fax Number	:	859-261-0969

Authorized Official
Title or Position	:	GEN MGR. / OWNER
Name	:	ANTHONY A. CIANCIOLO
Credential	:
Telephone Number	:	859-261-0101

Provider Enumeration Date	:	10/08/2008
Last Update Date	:	03/15/2011

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