Provider Demographics
NPI:1912002411
Name:ALLOCCA, CARLENE MARIE (RDH)
Entity Type:Individual
Prefix:
First Name:CARLENE
Middle Name:MARIE
Last Name:ALLOCCA
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 W LAKE DR
Mailing Address - Street 2:
Mailing Address - City:LINDENHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11757-6127
Mailing Address - Country:US
Mailing Address - Phone:631-225-6704
Mailing Address - Fax:
Practice Address - Street 1:163 HALF HOLLOW RD
Practice Address - Street 2:SUITE 1
Practice Address - City:DEER PARK
Practice Address - State:NY
Practice Address - Zip Code:11729-4232
Practice Address - Country:US
Practice Address - Phone:631-667-2820
Practice Address - Fax:631-667-3133
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022278124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist