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General NPI Number Information
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NPI Number | 1679363618
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Entity Type | Organization
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Legal Business Name | EAST HAVEN GENERAL AND IMPLANT DENTISTRY, PLLC
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Dates
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Enumeration Date | 05/12/2025
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Last Update Date | 05/12/2025
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Provider Practice Location Address
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Address Line | 1367 N HIGH ST
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City | EAST HAVEN
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State | CT
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Zip | 06512-1155
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Country | US
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Telephone | 203-468-8007
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Fax |
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Provider Business Mailing Address
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Address Line | 4178 W HENRIETTA RD STE B
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City | ROCHESTER
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State | NY
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Zip | 14623-5259
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Country | US
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Telephone | 585-360-0202
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Fax | 585-360-0134
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Authorized Official
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Title or Position | OWNER
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Name | ANTONIO CALASCIBETTA
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Credential |
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Telephone | 585-355-2141
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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