Provider Demographics
NPI:1548524200
Name:TESTA, ANTHONY A (DMD)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:A
Last Name:TESTA
Suffix:
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 1:14 MONMOUTH PARK PL
Mailing Address - Street 2:
Mailing Address - City:OCEANPORT
Mailing Address - State:NJ
Mailing Address - Zip Code:07757-1010
Mailing Address - Country:US
Mailing Address - Phone:732-687-3854
Mailing Address - Fax:
Practice Address - Street 1:225 HIGHWAY 35
Practice Address - Street 2:SUITE 106
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-5919
Practice Address - Country:US
Practice Address - Phone:732-741-7333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-27
Last Update Date:2013-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NJ22DI02511300122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program