Provider Demographics
NPI:1780854778
Name:DEGERONIMO, CHRISTINE A (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:A
Last Name:DEGERONIMO
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 1:12 VILLET DR
Mailing Address - Street 2:
Mailing Address - City:SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-2600
Mailing Address - Country:US
Mailing Address - Phone:631-675-6562
Mailing Address - Fax:
Practice Address - Street 1:26 EASTWOOD BLVD
Practice Address - Street 2:
Practice Address - City:CENTEREACH
Practice Address - State:NY
Practice Address - Zip Code:11720-2735
Practice Address - Country:US
Practice Address - Phone:631-588-6488
Practice Address - Fax:631-588-6227
Is Sole Proprietor?:No
Enumeration Date:2008-03-05
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0539281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice