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Individual

DAVID DERISSE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
DMD

Contact information

Practice address
129 WADSWORTH AVE APT 3, NEW YORK, NY 10033-4831
(212) 923-0505
(212) 568-5960
Mailing address
211 W 6TH AVE, ROSELLE, NJ 07203-1127

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
051680
NY

Other

Enumeration date
05/08/2007
Last updated
07/08/2007
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