Provider Demographics
NPI:1083618011
Name:DEGIACOMO, LOUIS PATRICK (DDS)
Entity Type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:PATRICK
Last Name:DEGIACOMO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 AMERICANA BLVD
Mailing Address - Street 2:
Mailing Address - City:HOPEWELL JUNCTION
Mailing Address - State:NY
Mailing Address - Zip Code:12533-6325
Mailing Address - Country:US
Mailing Address - Phone:845-221-0426
Mailing Address - Fax:845-221-0426
Practice Address - Street 1:1499 ROUTE 52
Practice Address - Street 2:STE 25
Practice Address - City:FISHKILL
Practice Address - State:NY
Practice Address - Zip Code:12524-1625
Practice Address - Country:US
Practice Address - Phone:845-897-5140
Practice Address - Fax:845-897-5141
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029208122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist