Individual provider · Type 1 NPI

Anthony Russell Immediata, DMD, PA

Oral and Maxillofacial Surgery (Dentist) · Raleigh, NC

NPI number 1609809292 Active

Practice location

7101 Creedmoor Rd, Suite 109
Raleigh, NC 27613-1682

Call (919) 846-5500 Map

Specialties and licenses

TaxonomyCodeLicense
Oral and Maxillofacial Surgery (Dentist) Primary 1223S0112X5022 (NC)

Oral and Maxillofacial Surgery (Dentist): The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region.

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About NPI 1609809292

Anthony Russell Immediata, DMD, PA's National Provider Identifier is 1609809292, issued on Jul 8, 2006. The primary taxonomy on file is Oral and Maxillofacial Surgery (Dentist) (1223S0112X), and the practice location is in Raleigh, NC. The record was last updated on Jul 8, 2007.