Healthcare Provider Details

I. General information

NPI: 1497960801
Provider Name (Legal Business Name): VINCENT THOMAS CAMMARATO D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 S STATE ST
DOVER DE
19901-4113
US

IV. Provider business mailing address

850 S STATE ST
DOVER DE
19901-4113
US

V. Phone/Fax

Practice location:
  • Phone: 302-736-6631
  • Fax: 302-736-6645
Mailing address:
  • Phone: 302-736-6631
  • Fax: 302-736-6645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberG1-0000871
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: