Provider Demographics
NPI:1992852966
Name:CAMMARATA, MARC SEBASTIAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:SEBASTIAN
Last Name:CAMMARATA
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 1:27900 NEW MARKET RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-3333
Mailing Address - Country:US
Mailing Address - Phone:248-553-3773
Mailing Address - Fax:
Practice Address - Street 1:27900 NEW MARKET RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-3333
Practice Address - Country:US
Practice Address - Phone:248-553-3773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI151351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice