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General NPI Number Information
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NPI Number | 1548370224
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Entity Type | Individual
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Provider Name | ANTHONY G DELUKE DDS
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Gender | Male
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 12/05/2024
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Provider Practice Location Address
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Address Line | 570 LANIER AVE W BLDG 2
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City | FAYETTEVILLE
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State | GA
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Zip | 30214-7649
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Country | US
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Telephone | 678-836-2128
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Fax |
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Provider Business Mailing Address
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Address Line | 2501 WINSLOW DR NE
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City | ATLANTA
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State | GA
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Zip | 30305-3742
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Country | US
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Telephone | 716-998-3463
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Fax | 716-998-3463
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 12558
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 34336
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | DN122764
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License Number State | GA
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