Provider Demographics
NPI:1881919405
Name:DEMEO, J SEPH ANTHONY (DMD, MS)
Entity type:Individual
Prefix:
First Name:J
Middle Name:SEPH ANTHONY
Last Name:DEMEO
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 E HILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:LOUDONVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12211-2618
Mailing Address - Country:US
Mailing Address - Phone:202-802-0984
Mailing Address - Fax:
Practice Address - Street 1:939 NY ROUTE 146
Practice Address - Street 2:STE 400
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065
Practice Address - Country:US
Practice Address - Phone:518-631-9771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-07
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT2761122300000X, 1223X0400X
VA04014128961223X0400X
NY0629461223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist