Provider Demographics
NPI:1982746756
Name:DELLEDONNE, DEAN F (DDS)
Entity Type:Individual
Prefix:DR
First Name:DEAN
Middle Name:F
Last Name:DELLEDONNE
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 1:110 MONTAUK HWY
Mailing Address - Street 2:
Mailing Address - City:MORICHES
Mailing Address - State:NY
Mailing Address - Zip Code:11955-1407
Mailing Address - Country:US
Mailing Address - Phone:631-878-4488
Mailing Address - Fax:631-878-7330
Practice Address - Street 1:110 MONTAUK HWY
Practice Address - Street 2:
Practice Address - City:MORICHES
Practice Address - State:NY
Practice Address - Zip Code:11955-1407
Practice Address - Country:US
Practice Address - Phone:631-878-4488
Practice Address - Fax:631-878-7330
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0359871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice