Provider Demographics
NPI:1972754919
Name:ANTHONY A. CIANCIOLO
Entity type:Organization
Organization Name:ANTHONY A. CIANCIOLO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:GEN MGR. / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:A
Authorized Official - Last Name:CIANCIOLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-261-0101
Mailing Address - Street 1:625 6TH AVE
Mailing Address - Street 2:FLOOR 1
Mailing Address - City:DAYTON
Mailing Address - State:KY
Mailing Address - Zip Code:41074-1483
Mailing Address - Country:US
Mailing Address - Phone:859-261-0101
Mailing Address - Fax:859-261-0969
Practice Address - Street 1:625 6TH AVE
Practice Address - Street 2:FLOOR 1
Practice Address - City:DAYTON
Practice Address - State:KY
Practice Address - Zip Code:41074-1483
Practice Address - Country:US
Practice Address - Phone:859-261-0101
Practice Address - Fax:859-261-0969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-08
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty