Provider Demographics
NPI:1326127788
Name:LIZZIO-LA BELLA, DOMINIQUE C (DDS)
Entity Type:Individual
Prefix:
First Name:DOMINIQUE
Middle Name:C
Last Name:LIZZIO-LA BELLA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 STEWART AVE
Mailing Address - Street 2:SUITE 225
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-4893
Mailing Address - Country:US
Mailing Address - Phone:516-747-2400
Mailing Address - Fax:516-747-0353
Practice Address - Street 1:901 STEWART AVE
Practice Address - Street 2:SUITE 225
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-4893
Practice Address - Country:US
Practice Address - Phone:516-747-2400
Practice Address - Fax:516-747-0353
Is Sole Proprietor?:No
Enumeration Date:2006-11-04
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0471791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice