Anthony R Lister, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

052886 Issued in NY

Practice address

114 S Shore Rd
Old Forge, NY 13420-7786

Phone

(315) 369-6634

NPI assigned

Jul 2, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1183334400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560988800000",
    "number": "1679770523",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 66",
            "city": "OLD FORGE",
            "state": "NY",
            "postal_code": "134200066",
            "telephone_number": "153-369-6634"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "114 S SHORE RD",
            "city": "OLD FORGE",
            "state": "NY",
            "postal_code": "134207786",
            "telephone_number": "315-369-6634"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LISTER",
        "first_name": "ANTHONY",
        "middle_name": "R",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-07-02",
        "last_updated": "2019-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "NY",
            "license": "052886",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "052886",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kelly E. Hamlin, RD, CDN
• Shelby Harwood, NP
• Megan Tara Heeder-Megan, LMHC
• Home Aide Service of the Central Adirondacks, Inc.
• KPH Healthcare Services, Inc.
• Old Forge Fire Department
• Old Forge Volunteer Ambulance Corps, Inc
• Julie Perlanski, MD
• Joseph C Rintrona, DDS
• Susan G Rundell, RPT

• General Practice Dentistry in Old Forge, NY
• Providers in Old Forge, NY by specialty
• General Practice Dentistry in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.