Provider Demographics
NPI:1760600373
Name:DUQUE, MARIA G (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:G
Last Name:DUQUE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:MARIA
Other - Middle Name:G
Other - Last Name:DUQUE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:6 BARTLETT PLACE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743
Mailing Address - Country:US
Mailing Address - Phone:631-351-0479
Mailing Address - Fax:
Practice Address - Street 1:2 BROOKSITE DR
Practice Address - Street 2:SUITE 110
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-3455
Practice Address - Country:US
Practice Address - Phone:631-979-3809
Practice Address - Fax:631-979-3810
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-22
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0458661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice