Provider Demographics
NPI:1629113329
Name:LACARRUBBA, JOSEPH J (DDS)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:J
Last Name:LACARRUBBA
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 1:2500 NESCONSET HWY
Mailing Address - Street 2:SUITE 11 A
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-2553
Mailing Address - Country:US
Mailing Address - Phone:631-751-7171
Mailing Address - Fax:631-751-7530
Practice Address - Street 1:2500 NESCONSET HWY
Practice Address - Street 2:SUITE 11 A
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11790-2553
Practice Address - Country:US
Practice Address - Phone:631-751-7171
Practice Address - Fax:631-751-7530
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047278 1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist