MEDICARE: DR. PAUL J. ANAGNOSTAKOS DMD

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	DS028253L	PA

General Provider Information

NPI Number	:	1760659361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL J. ANAGNOSTAKOS DMD

Provider Business Mailing Address
First Line	:	4 ARBOR LN
Second Line	:
City	:	FEASTERVILLE TREVOSE
State	:	PA
Zip	:	19053-4311
Country	:	US
Telephone Number	:	215-357-4321
Fax Number	:	215-942-7312

Provider Business Practice Location Address
First Line	:	4 ARBOR LN
Second Line	:
City	:	FEASTERVILLE TREVOSE
State	:	PA
Zip	:	19053-4311
Country	:	US
Telephone Number	:	215-357-4321
Fax Number	:	215-942-7312

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

Provider Enumeration Date	:	05/13/2008
Last Update Date	:	05/13/2008

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