Provider Demographics
NPI:1083892079
Name:JOHN TOCCAFONDI JR., DDS, PLLC
Entity Type:Organization
Organization Name:JOHN TOCCAFONDI JR., DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:BRUNO
Authorized Official - Last Name:TOCCAFONDI
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:914-693-0199
Mailing Address - Street 1:615 BROADWAY
Mailing Address - Street 2:SW1
Mailing Address - City:HASTINGS ON HUDSON
Mailing Address - State:NY
Mailing Address - Zip Code:10706-1039
Mailing Address - Country:US
Mailing Address - Phone:914-693-0199
Mailing Address - Fax:914-693-3569
Practice Address - Street 1:615 BROADWAY
Practice Address - Street 2:SW1
Practice Address - City:HASTINGS ON HUDSON
Practice Address - State:NY
Practice Address - Zip Code:10706-1039
Practice Address - Country:US
Practice Address - Phone:914-693-0199
Practice Address - Fax:914-693-3569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-01
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY04025211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty