Individual
ANTHONY COYLE FASI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS, MD
Contact information
Practice address
2058 SOUTH STATE STREET, SUITE 100, ANN ARBOR, MI 48104
(734) 769-5302
Mailing address
2058 SOUTH STATE STREET, SUITE 100, ANN ARBOR, MI 48104
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
2901020181
MI
390200000X
Student in an Organized Health Care Education/Training Program
2901020181
MI
Other
Enumeration date
05/21/2010
Last updated
10/06/2016
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