Provider Demographics
NPI:1649563933
Name:DEGEL, EDWARD J (DDS)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:J
Last Name:DEGEL
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 1:9242 QUEENS BLVD
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-1040
Mailing Address - Country:US
Mailing Address - Phone:718-429-6867
Mailing Address - Fax:718-429-4405
Practice Address - Street 1:9242 QUEENS BLVD
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-1040
Practice Address - Country:US
Practice Address - Phone:718-429-6867
Practice Address - Fax:718-429-4405
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-19
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045298122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist