Provider Demographics
NPI:1497152607
Name:ORESTE, DEBRA
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:ORESTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:157 N OCEAN AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-2016
Mailing Address - Country:US
Mailing Address - Phone:631-475-6444
Mailing Address - Fax:631-475-6941
Practice Address - Street 1:157 N OCEAN AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-2016
Practice Address - Country:US
Practice Address - Phone:631-475-6444
Practice Address - Fax:631-475-6941
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-03
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046643122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist