Healthcare Provider Details

I. General information

NPI: 1336931179
Provider Name (Legal Business Name): ANTHONY J DILUCENTE IV DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2025
Last Update Date: 08/07/2025
Certification Date: 08/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MSC06 3500 1 UNIVERSITY OF NEW MEXICO
ALBUQUERQUE NM
87131-0001
US

IV. Provider business mailing address

MSC06 3500 1 UNIVERSITY OF NEW MEXICO
ALBUQUERQUE NM
87131-0001
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-6000
  • Fax: 505-272-6003
Mailing address:
  • Phone: 505-272-6000
  • Fax: 505-272-6003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberDB-2025-0158
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: