Provider Demographics
NPI:1023532041
Name:BADALAMENTI, ANTHONY EMANUEL (DDS)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:EMANUEL
Last Name:BADALAMENTI
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 1:99 S GILLETTE AVE
Mailing Address - Street 2:
Mailing Address - City:BAYPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11705-2226
Mailing Address - Country:US
Mailing Address - Phone:631-766-5706
Mailing Address - Fax:
Practice Address - Street 1:99 S GILLETTE AVE
Practice Address - Street 2:
Practice Address - City:BAYPORT
Practice Address - State:NY
Practice Address - Zip Code:11705-2226
Practice Address - Country:US
Practice Address - Phone:631-376-2296
Practice Address - Fax:631-980-3574
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-01
Last Update Date:2024-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0429171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice