Provider Demographics
NPI:1235134537
Name:AMODIO, MICHAEL D (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:D
Last Name:AMODIO
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 1:204 QUINNIPIAC AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06473-3626
Mailing Address - Country:US
Mailing Address - Phone:203-865-4667
Mailing Address - Fax:203-787-2944
Practice Address - Street 1:204 QUINNIPIAC AVE
Practice Address - Street 2:
Practice Address - City:NORTH HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06473-3626
Practice Address - Country:US
Practice Address - Phone:203-865-4667
Practice Address - Fax:203-787-2944
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT44651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice