Provider Demographics
NPI:1922197896
Name:PROTA, CARL P (DMD)
Entity type:Individual
Prefix:DR
First Name:CARL
Middle Name:P
Last Name:PROTA
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 1:1367 N HIGH ST
Mailing Address - Street 2:
Mailing Address - City:EAST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06512-1155
Mailing Address - Country:US
Mailing Address - Phone:203-468-8007
Mailing Address - Fax:203-468-9121
Practice Address - Street 1:1367 N HIGH ST
Practice Address - Street 2:
Practice Address - City:EAST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06512-1155
Practice Address - Country:US
Practice Address - Phone:203-468-8007
Practice Address - Fax:203-468-9121
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT69841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice