Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 19209 | OH |
NPI | 1003106980 |
---|---|
Provider Name | Dr. Anthony Edward Bisconti |
First Address | Youngstown, OH 44514-3667 |
Second Address | Youngstown, OH 44514-3667 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2011 |
Last Update Date | 13/04/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0411665 | (05) | OH |