Provider Demographics
NPI:1316523509
Name:DECKER, ANTHONY BRIAN JR (DMD)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:BRIAN
Last Name:DECKER
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3080 SAINT ROSE PKWY UNIT 1070
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-3541
Mailing Address - Country:US
Mailing Address - Phone:941-301-1855
Mailing Address - Fax:
Practice Address - Street 1:3080 SAINT ROSE PKWY UNIT 1070
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-3541
Practice Address - Country:US
Practice Address - Phone:941-301-1855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-19
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN25431122300000X
NV7398122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist