Provider Demographics
NPI:1730398256
Name:RAO, ANTHONY OWEN (DMD)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:OWEN
Last Name:RAO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1137 E SANDPIPER DR UNIT 101
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-2002
Mailing Address - Country:US
Mailing Address - Phone:602-501-0743
Mailing Address - Fax:
Practice Address - Street 1:7821 N 35TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85051-6509
Practice Address - Country:US
Practice Address - Phone:602-841-0002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD6452122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist