NPIMap

Organization Active NPI

Anthony J Distefano III DDS PC

  • Dentist
  • Worcester, MA
National Provider Identifier
1780995894
Registry record updated Jun 24, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
12966 Issued in MA
Legal business name
ANTHONY J DISTEFANO III DDS PC
Practice address
562 Lincoln St
Worcester, MA 01605-1916
Phone
(508) 852-0854
Fax
(508) 853-0364
NPI assigned
Jun 24, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 24, 2010

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

Authorized official

Name
Dr. Anthony James Distefano III, D.D.S.
Title
Owner
Phone
(508) 852-0854

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 12966 MA Primary

Addresses

Primary practice location

562 Lincoln St
Worcester, MA 01605-1916

Mailing address

562 Lincoln St
Worcester, MA 01605-1916
Phone (508) 852-0854

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1277337600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1277337600000",
    "number": "1780995894",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "562 LINCOLN ST",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016051916",
            "telephone_number": "508-852-0854",
            "fax_number": "508-853-0364"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "562 LINCOLN ST",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016051916",
            "telephone_number": "508-852-0854",
            "fax_number": "508-853-0364"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANTHONY J DISTEFANO III DDS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-24",
        "last_updated": "2010-06-24",
        "status": "A",
        "authorized_official_last_name": "DISTEFANO",
        "authorized_official_first_name": "ANTHONY",
        "authorized_official_middle_name": "JAMES",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "508-852-0854",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "MA",
            "license": "12966",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Worcester, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.