Healthcare Provider Details

I. General information

NPI: 1295820710
Provider Name (Legal Business Name): NEESHA DUGGAL D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 11/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

187 KINGSTON AVE
WURTSBORO NY
12790-7624
US

IV. Provider business mailing address

187 KINGSTON AVE P.O. BOX 787
WURTSBORO NY
12790-7624
US

V. Phone/Fax

Practice location:
  • Phone: 845-888-8001
  • Fax: 845-888-8005
Mailing address:
  • Phone: 845-888-8001
  • Fax: 845-888-8005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number025983-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: