Provider Demographics
NPI:1093304990
Name:DEGIRALAMO, DAVID (DMD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:DEGIRALAMO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 VILLAGE GREEN SHOPPING CTR
Mailing Address - Street 2:
Mailing Address - City:BUDD LAKE
Mailing Address - State:NJ
Mailing Address - Zip Code:07828-1706
Mailing Address - Country:US
Mailing Address - Phone:973-347-8110
Mailing Address - Fax:
Practice Address - Street 1:100 VILLAGE GREEN SHOPPING CTR
Practice Address - Street 2:
Practice Address - City:BUDD LAKE
Practice Address - State:NJ
Practice Address - Zip Code:07828-1706
Practice Address - Country:US
Practice Address - Phone:973-347-8110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-14
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02813100122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist