Healthcare Provider Details

I. General information

NPI: 1407429004
Provider Name (Legal Business Name): ANTHONY GABRIEL MASSARO DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2021
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

343 WARRIOR RD
FORT STEWART GA
31314
US

IV. Provider business mailing address

247 BIRCHOLT GRV
POOLER GA
31322-9868
US

V. Phone/Fax

Practice location:
  • Phone: 578-020-4333
  • Fax:
Mailing address:
  • Phone: 954-299-6577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberDN26095
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN26095
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: