Provider Demographics
NPI:1366730798
Name:CARBONELLA, ANTHONY MARTIN IV (DMD)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:MARTIN
Last Name:CARBONELLA
Suffix:IV
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 1:3 WINTER RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SANDY HOOK
Mailing Address - State:CT
Mailing Address - Zip Code:06482-1099
Mailing Address - Country:US
Mailing Address - Phone:752-799-8644
Mailing Address - Fax:
Practice Address - Street 1:30 QUAKER FARMS RD
Practice Address - Street 2:
Practice Address - City:SOUTHBURY
Practice Address - State:CT
Practice Address - Zip Code:06488-2732
Practice Address - Country:US
Practice Address - Phone:203-580-4867
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-19
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI 02589400122300000X
CT132831223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist