Healthcare Provider Details

I. General information

NPI: 1497882542
Provider Name (Legal Business Name): ANTHONY M DELIBERATO DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24600 DETROIT ROAD #200
WESTLAKE OH
44145-2542
US

IV. Provider business mailing address

24600 DETROIT ROAD #200
WESTLAKE OH
44145-2542
US

V. Phone/Fax

Practice location:
  • Phone: 440-808-9809
  • Fax: 440-808-9984
Mailing address:
  • Phone: 440-808-9809
  • Fax: 440-808-9984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number30017780
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: