Individual
ANTHONY R LISTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
114 S SHORE RD, OLD FORGE, NY 13420-7786
(315) 369-6634
Mailing address
PO BOX 66, OLD FORGE, NY 13420-0066
(153) 369-6634
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
052886
NY
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
052886
NY
Other
Enumeration date
07/02/2007
Last updated
06/20/2019
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