Provider Demographics
NPI:1528136280
Name:SALLUSTIO, ANTHONY (DDS)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:
Last Name:SALLUSTIO
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 1:1300 ALLENHURST AVE
Mailing Address - Street 2:
Mailing Address - City:OCEAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07712-4033
Mailing Address - Country:US
Mailing Address - Phone:732-531-4046
Mailing Address - Fax:732-531-4060
Practice Address - Street 1:1300 ALLENHURST AVE
Practice Address - Street 2:
Practice Address - City:OCEAN
Practice Address - State:NJ
Practice Address - Zip Code:07712-4033
Practice Address - Country:US
Practice Address - Phone:732-531-4046
Practice Address - Fax:732-531-4060
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI 184941223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ877720Medicare ID - Type Unspecified