Provider Demographics
NPI:1497530174
Name:CAMILLERI, BRIDGET M (RDH)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:M
Last Name:CAMILLERI
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 RYERSON AVE
Mailing Address - Street 2:
Mailing Address - City:MANORVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11949-2409
Mailing Address - Country:US
Mailing Address - Phone:631-766-1143
Mailing Address - Fax:
Practice Address - Street 1:47 N COUNTRY RD
Practice Address - Street 2:
Practice Address - City:SHOREHAM
Practice Address - State:NY
Practice Address - Zip Code:11786-1300
Practice Address - Country:US
Practice Address - Phone:631-744-0111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-30
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029960124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist