Provider Demographics
NPI:1881897056
Name:DE MARCO, ANTHONY ROCCO (DDS)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:ROCCO
Last Name:DE MARCO
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 1:63 BEECH AVENUE
Mailing Address - Street 2:
Mailing Address - City:FARMINGVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11738-1629
Mailing Address - Country:US
Mailing Address - Phone:631-220-0073
Mailing Address - Fax:
Practice Address - Street 1:63 BEECH AVENUE
Practice Address - Street 2:
Practice Address - City:FARMINGVILLE
Practice Address - State:NY
Practice Address - Zip Code:11738-1629
Practice Address - Country:US
Practice Address - Phone:631-220-0073
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042905122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01653112020Medicaid