Provider Demographics
NPI:1831259068
Name:DESIENA, VIRGINIA ANNE (DDS)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:ANNE
Last Name:DESIENA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:VIRGINIA
Other - Middle Name:DESIENA
Other - Last Name:NASTASI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:360 BRADHURST AVE
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:NY
Mailing Address - Zip Code:10532
Mailing Address - Country:US
Mailing Address - Phone:914-769-1816
Mailing Address - Fax:914-769-2963
Practice Address - Street 1:360 BRADHURST AVE
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:NY
Practice Address - Zip Code:10532
Practice Address - Country:US
Practice Address - Phone:914-769-1816
Practice Address - Fax:914-769-2963
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042645122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist