Provider Demographics
NPI:1932541802
Name:GIDDON, DEREK (DDS)
Entity Type:Individual
Prefix:DR
First Name:DEREK
Middle Name:
Last Name:GIDDON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:290 W 12TH ST
Mailing Address - Street 2:#1F
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10014-1927
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4 METROTECH CTR
Practice Address - Street 2:LOBBY
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-8400
Practice Address - Country:US
Practice Address - Phone:718-403-0700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-22
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0566631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice