Healthcare Provider Details

I. General information

NPI: 1083618011
Provider Name (Legal Business Name): LOUIS PATRICK DEGIACOMO DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/08/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1499 ROUTE 52 STE 25
FISHKILL NY
12524-1625
US

IV. Provider business mailing address

14 AMERICANA BLVD
HOPEWELL JUNCTION NY
12533-6325
US

V. Phone/Fax

Practice location:
  • Phone: 845-897-5140
  • Fax: 845-897-5141
Mailing address:
  • Phone: 845-221-0426
  • Fax: 845-221-0426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number029208
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: