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NPI Code Detail

MEDICARE: ANTHONY FASCIANO, DMD, LLC

MEDICARE: ANTHONY FASCIANO, DMD, LLC
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
11223E0200XEndodonticsNJ17458NJ

General Provider Information

NPI Number : 1912072471
Entity Type Code : Organization
Provider Name (Legal Business Name) : ANTHONY FASCIANO, DMD, LLC
Provider Business Mailing Address
First Line : 617 E PALISADE AVE
Second Line :
City : ENGLEWOOD CLIFFS
State : NJ
Zip : 07632-1831
Country : US
Telephone Number : 201-894-0350
Fax Number : 201-541-6728
Provider Business Practice Location Address
First Line : 617 E PALISADE AVE
Second Line :
City : ENGLEWOOD CLIFFS
State : NJ
Zip : 07632-1831
Country : US
Telephone Number : 201-894-0350
Fax Number : 201-541-6728
Authorized Official
Title or Position : OWNER
Name : DR. ANTHONY FASCIANO
Credential : DMD
Telephone Number : 201-894-0350
Provider Enumeration Date : 11/21/2006
Last Update Date : 03/01/2012

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