Donald Joseph Annicelle, DDS
Individual provider Active NPI General Practice Dentistry · Bridgeport, CT
NPI 1306028030 · NPPES record last updated Jul 1, 2008
Key facts
- NPI
- 1306028030
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 009876 (CT)
- Practice address
- 4699 Main St
Suite 200
Bridgeport, CT 06606-1830 - Phone
- (203) 372-3726
- Fax
- (203) 374-1452
- NPI assigned
- Dec 5, 2007
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150508001069 | CT | Order and Referring Only - Other (Physician) |
6204155518 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 009876 | CT | MD | General Practice Dentistry |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 009876 | CT | Yes |
Addresses
Primary practice location
4699 Main St
Suite 200
Bridgeport, CT 06606-1830
Mailing address
4699 Main St
Suite 200
Bridgeport, CT 06606-1830
Phone (203) 372-3726
Other providers in Bridgeport, CT
- Andria Rodriguez LLC
- Lamouy Y. Anglin
- Geralda Angrand
- Derrick A Anim
- Fadi Ankah
- Francesca Rose Annunziato Royer
- Esra Anson
- Anthony Ciccaglione, MD PC
- Anthony G Santomauro MD
- Anthony J. Vallone, MD, PC
All providers in Bridgeport, CT · General Practice Dentistry in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 1, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.