Provider Demographics
NPI:1679708044
Name:DEVITA, ROBERT GREGORY (DMD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:GREGORY
Last Name:DEVITA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1 HOLLOW LN
Mailing Address - Street 2:SUITE 108
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1215
Mailing Address - Country:US
Mailing Address - Phone:516-869-3400
Mailing Address - Fax:516-869-3400
Practice Address - Street 1:1 HOLLOW LN
Practice Address - Street 2:SUITE 108
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1215
Practice Address - Country:US
Practice Address - Phone:516-869-3400
Practice Address - Fax:516-869-3400
Is Sole Proprietor?:No
Enumeration Date:2009-05-28
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY0306291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice