Provider Demographics
NPI:1174513014
Name:CODISPOTI, ANTHONY NONE (DDS)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:NONE
Last Name:CODISPOTI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2347 CHESTNUT HILL ST NW
Mailing Address - Street 2:
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-5822
Mailing Address - Country:US
Mailing Address - Phone:330-494-6290
Mailing Address - Fax:
Practice Address - Street 1:4565 DRESSLER RD NW
Practice Address - Street 2:SUITE 101
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-2549
Practice Address - Country:US
Practice Address - Phone:330-493-9457
Practice Address - Fax:330-493-8898
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH140561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice