Healthcare Provider Details

I. General information

NPI: 1952471559
Provider Name (Legal Business Name): ANTHONY JOHN FICARA D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1466 ALTAMONT AVE
SCHENECTADY NY
12303-2900
US

IV. Provider business mailing address

109 COUNTRY WALK RD
SCHENECTADY NY
12306-6710
US

V. Phone/Fax

Practice location:
  • Phone: 518-355-3303
  • Fax: 518-355-4220
Mailing address:
  • Phone: 518-356-5587
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number28388
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: