Provider Demographics
NPI:1073164505
Name:DEGROAT, KAREN L (RDH)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:L
Last Name:DEGROAT
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 CLOVER RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WESTTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10998-3801
Mailing Address - Country:US
Mailing Address - Phone:845-741-5283
Mailing Address - Fax:
Practice Address - Street 1:31 OAKLAND AVE
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:NY
Practice Address - Zip Code:10990-1522
Practice Address - Country:US
Practice Address - Phone:845-986-2929
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-25
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022716-1124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist