Provider Demographics
NPI:1639592397
Name:DEMICHELE, ANNAMARIA (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANNAMARIA
Middle Name:
Last Name:DEMICHELE
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 1:5210 W GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:CAMILLUS
Mailing Address - State:NY
Mailing Address - Zip Code:13031-2202
Mailing Address - Country:US
Mailing Address - Phone:315-487-9225
Mailing Address - Fax:315-487-3433
Practice Address - Street 1:5210 W GENESEE ST
Practice Address - Street 2:
Practice Address - City:CAMILLUS
Practice Address - State:NY
Practice Address - Zip Code:13031-2202
Practice Address - Country:US
Practice Address - Phone:315-487-9225
Practice Address - Fax:315-487-3433
Is Sole Proprietor?:No
Enumeration Date:2014-01-30
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045135-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice