Provider Demographics
NPI:1033150248
Name:CAMPITIELLO, RALPH (DMD)
Entity Type:Individual
Prefix:DR
First Name:RALPH
Middle Name:
Last Name:CAMPITIELLO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:518 HAMBURG TPKE
Mailing Address - Street 2:
Mailing Address - City:POMPTON LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07442-1430
Mailing Address - Country:US
Mailing Address - Phone:973-835-0193
Mailing Address - Fax:973-835-0113
Practice Address - Street 1:518 HAMBURG TURNPIKE
Practice Address - Street 2:
Practice Address - City:POMPTON LAKES
Practice Address - State:NJ
Practice Address - Zip Code:07442-1430
Practice Address - Country:US
Practice Address - Phone:973-835-0193
Practice Address - Fax:973-835-0113
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ11612122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist