Individual
NEETHA ANIYA ANTONY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BDS
Contact information
Practice address
1 COLLEGE ST, PORTLAND, ME 04103-2617
(207) 221-4714
Mailing address
17 WINCHESTER DR UNIT 202, PORTLAND, ME 04103-5243
(669) 225-8208
Taxonomy
Speciality
Code
Description
License number
State
1223X2210X
Orofacial Pain Dentistry
Primary
DEN5072
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DEN5072
DENTAL LICENSE
ME
Enumeration date
09/04/2023
Last updated
09/13/2023
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