Healthcare Provider Details

I. General information

NPI: 1851607766
Provider Name (Legal Business Name): ARCHANA ANTONY DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2010
Last Update Date: 12/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 MAGNOLIA AVE SW
WINTER HAVEN FL
33880-2943
US

IV. Provider business mailing address

47 5TH ST NW
WINTER HAVEN FL
33881-4672
US

V. Phone/Fax

Practice location:
  • Phone: 863-291-5110
  • Fax: 863-291-5128
Mailing address:
  • Phone: 863-291-5110
  • Fax: 863-291-5128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberHAD 80
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: