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General NPI Number Information
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NPI Number | 1801099882
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Entity Type | Individual
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Provider Name | ANTHONY JOSEPH VISCONTI III D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/07/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 333 E NEW YORK AVE SUITE B
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City | DELAND
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State | FL
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Zip | 32724-5562
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Country | US
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Telephone | 386-734-7330
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Fax | 386-734-0329
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Provider Business Mailing Address
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Address Line | 333 EAST NEW YORK AVE. SUITE B
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City | DELAND
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State | FL
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Zip | 32724
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Country | US
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Telephone | 386-734-7330
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Fax | 386-734-0329
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | DN-14130
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License Number State | FL
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