Healthcare Provider Details

I. General information

NPI: 1396905550
Provider Name (Legal Business Name): CLIFFORD L. ANZILOTTI, D.M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2008
Last Update Date: 06/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 FOULK RD
WILMINGTON DE
19810-4710
US

IV. Provider business mailing address

2101 FOULK RD
WILMINGTON DE
19810-4710
US

V. Phone/Fax

Practice location:
  • Phone: 302-475-2050
  • Fax:
Mailing address:
  • Phone: 302-475-2050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number1990015088
License Number StateDE

VIII. Authorized Official

Name: DR. CLIFFORD L. ANZILOTTI JR.
Title or Position: PRESIDENT
Credential: D.M.D.
Phone: 302-475-2050