Provider Demographics
NPI:1659477172
Name:DELUCIA FEARMAN, LAURIE ANNE (DDS)
Entity Type:Individual
Prefix:DR
First Name:LAURIE
Middle Name:ANNE
Last Name:DELUCIA FEARMAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MRS
Other - First Name:LAURIE
Other - Middle Name:ANNE
Other - Last Name:DELUCIA-DERANJA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:105 LAKE HILL ROAD.
Mailing Address - Street 2:
Mailing Address - City:BURNT HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:12027
Mailing Address - Country:US
Mailing Address - Phone:518-399-4290
Mailing Address - Fax:518-399-5807
Practice Address - Street 1:105 LAKE HILL ROAD.
Practice Address - Street 2:
Practice Address - City:BURNT HILLS
Practice Address - State:NY
Practice Address - Zip Code:12027
Practice Address - Country:US
Practice Address - Phone:518-399-4290
Practice Address - Fax:518-399-5807
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0519381122300000X
NY051938122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist