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General NPI Number Information
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NPI Number | 1083618011
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Entity Type | Individual
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Provider Name | LOUIS PATRICK DEGIACOMO DDS
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Gender | Male
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Dates
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Enumeration Date | 06/08/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1499 ROUTE 52 STE 25
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City | FISHKILL
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State | NY
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Zip | 12524-1625
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Country | US
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Telephone | 845-897-5140
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Fax | 845-897-5141
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Provider Business Mailing Address
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Address Line | 14 AMERICANA BLVD
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City | HOPEWELL JUNCTION
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State | NY
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Zip | 12533-6325
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Country | US
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Telephone | 845-221-0426
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Fax | 845-221-0426
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 029208
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License Number State | NY
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