Healthcare Provider Details

I. General information

NPI: 1356432454
Provider Name (Legal Business Name): DENISE L EMMA DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 7TH ST
GARDEN CITY NY
11530-2800
US

IV. Provider business mailing address

70 7TH ST
GARDEN CITY NY
11530-2800
US

V. Phone/Fax

Practice location:
  • Phone: 516-741-7970
  • Fax: 516-741-2955
Mailing address:
  • Phone: 516-741-7970
  • Fax: 516-741-2955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number044925
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: