Provider Demographics
NPI:1174783419
Name:GEREMINO, MICHAEL JOSEPH (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:GEREMINO
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 1:47 BROOKFIELD PL
Mailing Address - Street 2:
Mailing Address - City:PLEASANTVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10570-2107
Mailing Address - Country:US
Mailing Address - Phone:914-769-0065
Mailing Address - Fax:914-769-3214
Practice Address - Street 1:47 BROOKFIELD PL
Practice Address - Street 2:
Practice Address - City:PLEASANTVILLE
Practice Address - State:NY
Practice Address - Zip Code:10570-2107
Practice Address - Country:US
Practice Address - Phone:914-769-0065
Practice Address - Fax:914-769-3214
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-10
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0434211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice