Provider Demographics
NPI:1598217341
Name:FIORETTI, ANTHONY GEORGE (DDS)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:GEORGE
Last Name:FIORETTI
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 1:742 W CHERRY LN
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-1617
Mailing Address - Country:US
Mailing Address - Phone:208-888-1010
Mailing Address - Fax:208-888-4488
Practice Address - Street 1:742 W CHERRY LN
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-1617
Practice Address - Country:US
Practice Address - Phone:208-888-1010
Practice Address - Fax:208-888-4488
Is Sole Proprietor?:No
Enumeration Date:2016-10-27
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100519122300000X, 390200000X
IDD-EN-53321223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD0000Medicare UPIN