Provider Demographics
NPI:1215417274
Name:DIMICELLI, ROSEMARY (DENTAL HYGIENIST)
Entity Type:Individual
Prefix:MS
First Name:ROSEMARY
Middle Name:
Last Name:DIMICELLI
Suffix:
Gender:F
Credentials:DENTAL HYGIENIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3016 CODDINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-6004
Mailing Address - Country:US
Mailing Address - Phone:347-231-6205
Mailing Address - Fax:
Practice Address - Street 1:565 MANHATTAN AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-5250
Practice Address - Country:US
Practice Address - Phone:347-231-6205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-20
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0181931124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist