Healthcare Provider Details

I. General information

NPI: 1295665156
Provider Name (Legal Business Name): ANTHONY JOSEPH DEBELLA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1790 7TH ST E
SAINT PAUL MN
55119-3419
US

IV. Provider business mailing address

2800 WAYZATA BLVD APT 101
MINNEAPOLIS MN
55405-2149
US

V. Phone/Fax

Practice location:
  • Phone: 651-735-0595
  • Fax:
Mailing address:
  • Phone: 239-776-9033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD15440
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: