MEDICARE: KAREN L DEGROAT RDH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	124Q00000X	Dental Hygienist	022716-1	NY

General Provider Information

NPI Number	:	1073164505
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN L DEGROAT RDH

Provider Business Mailing Address
First Line	:	32 CLOVER RIDGE RD
Second Line	:
City	:	WESTTOWN
State	:	NY
Zip	:	10998-3801
Country	:	US
Telephone Number	:	845-741-5283
Fax Number	:

Provider Business Practice Location Address
First Line	:	31 OAKLAND AVE
Second Line	:
City	:	WARWICK
State	:	NY
Zip	:	10990-1522
Country	:	US
Telephone Number	:	845-986-2929
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/25/2019
Last Update Date	:	09/25/2019

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