Healthcare Provider Details

I. General information

NPI: 1245367622
Provider Name (Legal Business Name): ANTHONY JOSEPH CAMILLO DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 NEWTOWN RD
DANBURY CT
06810-4146
US

IV. Provider business mailing address

107 NEWTOWN RD
DANBURY CT
06810-4146
US

V. Phone/Fax

Practice location:
  • Phone: 203-797-0012
  • Fax: 203-797-0123
Mailing address:
  • Phone: 203-797-0012
  • Fax: 203-797-0123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number008286
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: