Active NPI
Anthony Destefano, DMD
- Dentist
- Morrisville, NC
National Provider Identifier
1255495370
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 8692
- Practice address
- 6101 Grace Park Dr
Morrisville, NC 27560-6003 - Phone
- (919) 571-2484
- Fax
- (919) 571-2486
- NPI assigned
- Dec 21, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DS036173 | PA | |
| Dentist | 122300000X | 8692 | NC | Primary |
Addresses
Primary practice location
6101 Grace Park Dr
Morrisville, NC 27560-6003
Mailing address
6101 Grace Park Dr
Morrisville, NC 27560-6003
Phone (919) 571-2484
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DS036173 | PA | MD | Dentist |
| 8692 | NC | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166659200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1294704000000",
"number": "1255495370",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6101 GRACE PARK DR",
"city": "MORRISVILLE",
"state": "NC",
"postal_code": "275606003",
"telephone_number": "919-571-2484",
"fax_number": "919-571-2486"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6101 GRACE PARK DR",
"city": "MORRISVILLE",
"state": "NC",
"postal_code": "275606003",
"telephone_number": "919-571-2484",
"fax_number": "919-571-2486"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DESTEFANO",
"first_name": "ANTHONY",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-12-21",
"last_updated": "2011-01-11",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "PA",
"license": "DS036173",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NC",
"license": "8692",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Morrisville, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.