Healthcare Provider Details

I. General information

NPI: 1255424867
Provider Name (Legal Business Name): ANGELO ALBERTO CARNEVALE DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4105 U.S.ROUTE #1, UNIT 15
MONMOUTH JUNCTION NJ
08852
US

IV. Provider business mailing address

4105 U.S.ROUTE #1 UNIT 15
MONMOUTH JUNCTION NJ
08852
US

V. Phone/Fax

Practice location:
  • Phone: 732-438-0988
  • Fax:
Mailing address:
  • Phone: 732-438-0988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number22DI01519800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: