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Deactivated NPI 1295731453 Deactivated / Inactive NPI Male Practitioner

Dr. Anthony L Tiberio , DDS

Dentist - General Practice • Southfield, MI

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Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Dr. Anthony Tiberio has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date June 22, 2005
NPI Deactivation Date March 20, 2006
Total Practice Duration ~1 Years of Practice (2005 – 2006)

Professional Overview & Biography Verified Profile Summary

Dr. Anthony Tiberio, DDS was a registered Dentist - General Practice practicing in Southfield, MI. Throughout an active medical career spanning 1 years, Dr. Tiberio provided care at the practice location at 21500 NORTHWESTERN HWY until profile deactivation on 2006-03-20.

Practice Location & Contact Primary Location

Practice Address

21500 Northwestern Hwy
Ste 640

Southfield, MI 480755010

Telephone 2485520166
Associated Practice Facility / Clinic
🏢 Northeast Dental Group Facility NPI 1023195922

Specialty Benchmarks & Practice Insights

Comparative analytics for Dentist - General Practice in Southfield, MI

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 15.8 Yrs
Regional Practice Density
74 Specialists

Practicing in Southfield, MI (4360 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

Dentist - General Practice Primary Specialty

NUCC Taxonomy Code: 1223G0001X

State License MI 14204

A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

2 Associated Practitioners
NPI 1093012353

Doctor of Dental Surgery, Master of Science

Dr. Robert Goodman , DMD

Dentist - General Practice

NPI 1720165228

Doctor of Dental Medicine

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

8 Historical Events
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NPI Profile Deactivated January 21, 2020

Record deactivated on January 21, 2020

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Updated Practice Location July 25, 2007

Registered at 21500 NORTHWESTERN HWY, STE 640, SOUTHFIELD, MI 480755010 (Tel: 2485520166)

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Updated Business Mailing Address July 25, 2007

Registered at 21500 NORTHWESTERN HWY, STE 640, SOUTHFIELD, MI 480755010 (Tel: 2485520166)

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Provider Name / Credentials Updated July 25, 2007

Recorded as ANTHONY TIBERIO, DDS

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Medical Taxonomy / Specialty Registered (Primary Specialty) July 25, 2007

Dentist (License #14204 in MI)

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NPI Profile Reactivated April 18, 2006

Record officially reactivated for active practice on April 18, 2006

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NPI Profile Deactivated March 20, 2006

Record deactivated on March 20, 2006

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Initial NPI Registration & Enumeration June 22, 2005

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1295731453
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: June 22, 2005
Last Update: July 25, 2007
Deactivation Date: March 20, 2006

Mailing Address

21500 Northwestern Hwy, Ste 640

Southfield, MI 480755010

Phone: 2485520166

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.