Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Dr. Anthony Russell Immediata, DMD, PA

Individual provider Oral and Maxillofacial Surgery (Dentist) · NPI 1609809292

Dr. Anthony Russell Immediata, DMD, PA is an Oral and Maxillofacial Surgery (Dentist) in Raleigh, North Carolina. Practices as a sole proprietor. Licensed in North Carolina.

Licensed in
NC
In the registry since
2006
What do these letters mean?
DMD — Doctor of Dental Medicine
A dentist. Identical training and licensing to a DDS.
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

7101 Creedmoor Rd Ste 109
Raleigh, NC 27613-1682
Phone: (919) 846-5500
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Oral and Maxillofacial Surgery (Dentist) (primary) Taxonomy 1223S0112X · Licence 5022 (NC)

Record details

NPI number1609809292
Entity typeIndividual (Type 1)
GenderMale
Credentials DMD , PA
Sole proprietorYes
NPI enumeratedJuly 8, 2006
Last updated in NPPESJuly 8, 2007

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