Provider Demographics
NPI:1811954795
Name:CARNEVALE, ROBERT S (DMD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:S
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 1:2 SHAWS CV STE 200
Mailing Address - Street 2:
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:860-889-1794
Practice Address - Street 1:2 SHAWS CV STE 200
Practice Address - Street 2:
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:860-889-1794
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT70151223P0300X
RI22521223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics