Provider Demographics
NPI:1285888065
Name:MAGGIO, DOUGLAS LEONARD
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:LEONARD
Last Name:MAGGIO
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:DOUGLAS
Other - Middle Name:L
Other - Last Name:MAGGIO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:1117 166TH ST
Mailing Address - Street 2:
Mailing Address - City:WHITESTONE
Mailing Address - State:NY
Mailing Address - Zip Code:11357-2801
Mailing Address - Country:US
Mailing Address - Phone:718-746-1865
Mailing Address - Fax:718-746-1998
Practice Address - Street 1:1117 166TH ST
Practice Address - Street 2:
Practice Address - City:WHITESTONE
Practice Address - State:NY
Practice Address - Zip Code:11357-2801
Practice Address - Country:US
Practice Address - Phone:718-746-1865
Practice Address - Fax:718-746-1998
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-06
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0409641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice