Provider Demographics
NPI:1689733388
Name:DIMARCO, ZOEY GAIL (DMD)
Entity Type:Individual
Prefix:MRS
First Name:ZOEY
Middle Name:GAIL
Last Name:DIMARCO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 S LAKESIDE AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE HOPATCONG
Mailing Address - State:NJ
Mailing Address - Zip Code:07849-1651
Mailing Address - Country:US
Mailing Address - Phone:973-886-2730
Mailing Address - Fax:973-328-6817
Practice Address - Street 1:17 S WARREN ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NJ
Practice Address - Zip Code:07801-4506
Practice Address - Country:US
Practice Address - Phone:873-328-3344
Practice Address - Fax:973-328-6817
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02213904122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0038750Medicaid