MEDICARE: DR. ANTHONY VINCENT SPERDUTO DDS

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	122300000X	Dentist	11232	KY

General Provider Information

NPI Number	:	1700618089
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANTHONY VINCENT SPERDUTO DDS

Provider Business Mailing Address
First Line	:	121 THOROUGHBRED DR
Second Line	:
City	:	HOPKINSVILLE
State	:	KY
Zip	:	42240-1403
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4131 FORT CAMPBELL BLVD
Second Line	:
City	:	HOPKINSVILLE
State	:	KY
Zip	:	42240-8706
Country	:	US
Telephone Number	:	270-987-3006
Fax Number	:

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

Provider Enumeration Date	:	08/15/2024
Last Update Date	:	08/15/2024

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