Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 049152-1 | NY |
NPI | 1841253788 |
---|---|
Provider Name | Dr. Denise Amanda Trochesset |
First Address | Stony Brook, NY 11794-8705 |
Second Address | Stony Brook, NY 11794-8705 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2006 |
Last Update Date | 28/12/2011 |