Provider Demographics
NPI:1063947364
Name:DI FRISCO, DOMINICK JAMES (DDS)
Entity type:Individual
Prefix:
First Name:DOMINICK
Middle Name:JAMES
Last Name:DI FRISCO
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 1:18 TERRACE PARK LN
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10805-1456
Mailing Address - Country:US
Mailing Address - Phone:914-684-1894
Mailing Address - Fax:914-437-8770
Practice Address - Street 1:18 TERRACE PARK LN
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10805-1456
Practice Address - Country:US
Practice Address - Phone:914-684-1894
Practice Address - Fax:914-437-8770
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-24
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0222981122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist