Provider Demographics
NPI:1437371341
Name:PASQUA, ALYSE K (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALYSE
Middle Name:K
Last Name:PASQUA
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 1:1 HORIZON DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-4409
Mailing Address - Country:US
Mailing Address - Phone:631-271-9819
Mailing Address - Fax:631-692-6419
Practice Address - Street 1:1 HORIZON DR
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-4409
Practice Address - Country:US
Practice Address - Phone:631-271-9819
Practice Address - Fax:631-692-6419
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045102122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist