Provider Demographics
NPI:1346456019
Name:IOVINO, ROBERT PASCAL (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:PASCAL
Last Name:IOVINO
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 1:351 MEETING HOUSE LN
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:11968-5051
Mailing Address - Country:US
Mailing Address - Phone:631-283-5626
Mailing Address - Fax:631-283-5627
Practice Address - Street 1:351 MEETING HOUSE LN
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11968-5051
Practice Address - Country:US
Practice Address - Phone:631-283-5626
Practice Address - Fax:631-283-5627
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0341531223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYT50062Medicare UPIN
NYD7D251Medicare ID - Type UnspecifiedMEDICARE