Provider Demographics
NPI:1043490139
Name:DIBONA-SCAMARDELLA, KAREN (DDS)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:
Last Name:DIBONA-SCAMARDELLA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:KAREN
Other - Middle Name:
Other - Last Name:DIBONA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:646 WILLOWBROOK RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-6826
Mailing Address - Country:US
Mailing Address - Phone:718-698-7500
Mailing Address - Fax:718-494-8858
Practice Address - Street 1:646 WILLOWBROOK RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-6826
Practice Address - Country:US
Practice Address - Phone:718-698-7500
Practice Address - Fax:718-494-8858
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-06
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0412031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice