Provider Demographics
NPI:1124231279
Name:CORRAO, ANTHONY ALBERT (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:ALBERT
Last Name:CORRAO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 AYERS POINT RD
Mailing Address - Street 2:
Mailing Address - City:OLD SAYBROOK
Mailing Address - State:CT
Mailing Address - Zip Code:06475-4301
Mailing Address - Country:US
Mailing Address - Phone:860-388-4383
Mailing Address - Fax:
Practice Address - Street 1:6 DAVIS RD W
Practice Address - Street 2:
Practice Address - City:OLD LYME
Practice Address - State:CT
Practice Address - Zip Code:06371-1448
Practice Address - Country:US
Practice Address - Phone:860-434-5565
Practice Address - Fax:860-434-5880
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT42491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT4249OtherSTATE LICENSE