MEDICARE: DR. JOSEPH ANZELMO D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	2571	LA

General Provider Information

NPI Number	:	1427001569
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH ANZELMO D.D.S.

Provider Business Mailing Address
First Line	:	4001 LAPALCO BLVD
Second Line	:	SUITE 10
City	:	HARVEY
State	:	LA
Zip	:	70058-2389
Country	:	US
Telephone Number	:	504-340-0076
Fax Number	:	504-340-0078

Provider Business Practice Location Address
First Line	:	4001 LAPALCO BLVD
Second Line	:	SUITE 10
City	:	HARVEY
State	:	LA
Zip	:	70058-2389
Country	:	US
Telephone Number	:	504-340-0076
Fax Number	:	504-340-0078

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	07/08/2007

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