Provider Demographics
NPI:1700053709
Name:ROBERT S. CARNEVALE, DMD, PC
Entity Type:Organization
Organization Name:ROBERT S. CARNEVALE, DMD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:S
Authorized Official - Last Name:CARNEVALE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:860-443-1114
Mailing Address - Street 1:2 SHAWS CV
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NEW LONDON
Mailing Address - State:CT
Mailing Address - Zip Code:06320-4975
Mailing Address - Country:US
Mailing Address - Phone:860-443-1114
Mailing Address - Fax:
Practice Address - Street 1:2 SHAWS CV
Practice Address - Street 2:SUITE 200
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320-4975
Practice Address - Country:US
Practice Address - Phone:860-443-1114
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-09
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT70151223P0300X
RI22521223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty