Provider Demographics
NPI:1548397292
Name:FLAGIELLO, RAYMOND (DDS)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:
Last Name:FLAGIELLO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1235 RICHMOND RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-2445
Mailing Address - Country:US
Mailing Address - Phone:718-351-2323
Mailing Address - Fax:718-980-2066
Practice Address - Street 1:1235 RICHMOND RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-2445
Practice Address - Country:US
Practice Address - Phone:718-351-2323
Practice Address - Fax:718-980-2066
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040970-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice