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Organization

ANTHONY DICOSTANZO DDS PC

Active
Other names
Smiles By Doctor D
Organization subpart
No

Provider details

NPI number
Authorized official
MARTI BENNE (OFFICE MANANGER)
(219) 865-3303
Entity
Organization

Contact information

Practice address
1123 JOLIET ST, DYER, IN 46311-1926
(219) 865-3303
(219) 865-3244
Mailing address
1123 JOLIET ST, DYER, IN 46311-1926
(219) 865-3303
(219) 865-3244

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12007851A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
100168120A
IN
Enumeration date
06/17/2015
Last updated
06/17/2015
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