Provider Demographics
NPI:1134360068
Name:DEMASO, ALAN J (DMD)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:J
Last Name:DEMASO
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 1:2604 AMBOY ROAD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-2263
Mailing Address - Country:US
Mailing Address - Phone:718-351-0188
Mailing Address - Fax:718-351-2818
Practice Address - Street 1:2604 AMBOY RD.
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-2263
Practice Address - Country:US
Practice Address - Phone:718-351-0188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-24
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038774-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice