Provider Demographics
NPI:1255424867
Name:CARNEVALE, ANGELO ALBERTO (DMD)
Entity type:Individual
Prefix:
First Name:ANGELO
Middle Name:ALBERTO
Last Name:CARNEVALE
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 1:4105 U.S.ROUTE #1 UNIT 15
Mailing Address - Street 2:
Mailing Address - City:MONMOUTH JUNCTION
Mailing Address - State:NJ
Mailing Address - Zip Code:08852
Mailing Address - Country:US
Mailing Address - Phone:732-438-0988
Mailing Address - Fax:
Practice Address - Street 1:4105 U.S.ROUTE #1, UNIT 15
Practice Address - Street 2:
Practice Address - City:MONMOUTH JUNCTION
Practice Address - State:NJ
Practice Address - Zip Code:08852
Practice Address - Country:US
Practice Address - Phone:732-438-0988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI015198001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice