Provider Demographics
NPI:1801016910
Name:DISCEPOLA, PATRICK R (DMD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:R
Last Name:DISCEPOLA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 MONMOUTH RD
Mailing Address - Street 2:
Mailing Address - City:WEST LONG BRANCH
Mailing Address - State:NJ
Mailing Address - Zip Code:07764-1031
Mailing Address - Country:US
Mailing Address - Phone:732-870-0007
Mailing Address - Fax:732-870-0151
Practice Address - Street 1:211 MONMOUTH RD
Practice Address - Street 2:
Practice Address - City:WEST LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07764-1031
Practice Address - Country:US
Practice Address - Phone:732-870-0007
Practice Address - Fax:732-870-0151
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI01409400122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist