Healthcare Provider Details

I. General information

NPI: 1922106517
Provider Name (Legal Business Name): DESIREE LARACUENTE D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3209 82ND ST STE 1
EAST ELMHURST NY
11370-2003
US

IV. Provider business mailing address

3209 82ND ST APT 1
EAST ELMHURST NY
11370-2003
US

V. Phone/Fax

Practice location:
  • Phone: 718-898-0600
  • Fax: 718-898-0700
Mailing address:
  • Phone: 718-898-0600
  • Fax: 718-898-0700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number053544
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: