Provider Demographics
NPI:1679609739
Name:IACOBUCCI, ANTHONY CARL (DDS)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:CARL
Last Name:IACOBUCCI
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 1:6789 RIDGE RD
Mailing Address - Street 2:SUITE 306
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44129-5649
Mailing Address - Country:US
Mailing Address - Phone:440-845-6420
Mailing Address - Fax:
Practice Address - Street 1:6789 RIDGE RD
Practice Address - Street 2:SUITE 306
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44129-5649
Practice Address - Country:US
Practice Address - Phone:440-845-6420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH128851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice