Provider Demographics
NPI:1326018300
Name:SANTA LOCASCIO DDS PC
Entity Type:Organization
Organization Name:SANTA LOCASCIO DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:DR
Authorized Official - First Name:SANTA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOCASCIO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-628-6588
Mailing Address - Street 1:70-16 FRESH POND RD
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11414
Mailing Address - Country:US
Mailing Address - Phone:718-628-6588
Mailing Address - Fax:718-628-9579
Practice Address - Street 1:7016 FRESH POND RD
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NY
Practice Address - Zip Code:11385-5902
Practice Address - Country:US
Practice Address - Phone:718-628-6588
Practice Address - Fax:718-628-9579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-24
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01197731Medicaid