Provider Demographics
NPI:1215932181
Name:DENICCO, ANTHONY M (DDS)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:M
Last Name:DENICCO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1630 E HIGH ST
Mailing Address - Street 2:BLDG 4
Mailing Address - City:POTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19464-3244
Mailing Address - Country:US
Mailing Address - Phone:610-326-7880
Mailing Address - Fax:610-326-5491
Practice Address - Street 1:1630 E HIGH ST
Practice Address - Street 2:BLDG 4
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19464-3244
Practice Address - Country:US
Practice Address - Phone:610-326-7880
Practice Address - Fax:610-326-5491
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-015993L1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0048312000OtherAMERIHEALTH
PA0048312000OtherPERSONAL CHOICE
PA4100947OtherAETNA COMMERCIAL PLANS
PA03208501OtherCAPITAL BLUE CROSS
PA2422619OtherAETNA HMO
PADE062812OtherHIGHMARK
PA0048312000OtherKEYSTONE HEALTH PLAN EAST
PA1177183-006OtherCIGNA
PA2422619OtherAETNA HMO
PA062812FRDMedicare ID - Type UnspecifiedMEDICARE