Healthcare Provider Details

I. General information

NPI: 1598217341
Provider Name (Legal Business Name): ANTHONY GEORGE FIORETTI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2016
Last Update Date: 05/13/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

742 W CHERRY LN
MERIDIAN ID
83642-1617
US

IV. Provider business mailing address

742 W CHERRY LN
MERIDIAN ID
83642-1617
US

V. Phone/Fax

Practice location:
  • Phone: 208-888-1010
  • Fax: 208-888-4488
Mailing address:
  • Phone: 208-888-1010
  • Fax: 208-888-4488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number100519
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number100519
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberD-EN-5332
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: