Healthcare Provider Details

I. General information

NPI: 1841253788
Provider Name (Legal Business Name): DENISE AMANDA TROCHESSET DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 12/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

STONY BROOK DENTAL ASSOCIATES SULLIVAN HALL, ROOM 170
STONY BROOK NY
11794-8705
US

IV. Provider business mailing address

STONY BROOK DENTAL ASSOCIATES SULLIVAN HALL RM. 170
STONY BROOK NY
11794-8705
US

V. Phone/Fax

Practice location:
  • Phone: 631-632-8971
  • Fax:
Mailing address:
  • Phone: 631-632-8971
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number049152-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: