MEDICARE: DESIREE LARACUENTE D.M.D.

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	1223P0221X	Pediatric Dentistry	053544	NY
2	390200000X	Student in an Organized Health Care Education/Training Program

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922106517
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DESIREE LARACUENTE D.M.D.

Provider Business Mailing Address
First Line	:	3209 82ND ST APT 1
Second Line	:
City	:	EAST ELMHURST
State	:	NY
Zip	:	11370-2003
Country	:	US
Telephone Number	:	718-898-0600
Fax Number	:	718-898-0700

Provider Business Practice Location Address
First Line	:	3209 82ND ST STE 1
Second Line	:
City	:	EAST ELMHURST
State	:	NY
Zip	:	11370-2003
Country	:	US
Telephone Number	:	718-898-0600
Fax Number	:	718-898-0700

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

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	02/16/2026

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