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General NPI Number Information
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NPI Number | 1780854778
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Entity Type | Individual
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Provider Name | CHRISTINE A DEGERONIMO DDS
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Gender | Female
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Dates
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Enumeration Date | 03/05/2008
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Last Update Date | 04/13/2017
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Provider Practice Location Address
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Address Line | 26 EASTWOOD BLVD
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City | CENTEREACH
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State | NY
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Zip | 11720-2735
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Country | US
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Telephone | 631-588-6488
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Fax | 631-588-6227
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Provider Business Mailing Address
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Address Line | 12 VILLET DR
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City | SETAUKET
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State | NY
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Zip | 11733-2600
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Country | US
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Telephone | 631-675-6562
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Fax |
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 053928
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License Number State | NY
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