Provider Demographics
NPI:1285736710
Name:DIRENZO, ANTHONY JAMES (DDS)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:JAMES
Last Name:DIRENZO
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 1:60 MARWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-6249
Mailing Address - Country:US
Mailing Address - Phone:330-965-8669
Mailing Address - Fax:
Practice Address - Street 1:60 MARWOOD CIR
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-6249
Practice Address - Country:US
Practice Address - Phone:330-965-8669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH210161223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics