Provider Demographics
NPI:1437178902
Name:DISANTIS, EDWARD JOHN II (DMD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:JOHN
Last Name:DISANTIS
Suffix:II
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 E OHIO ST
Mailing Address - Street 2:SUITE 275
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15212-5586
Mailing Address - Country:US
Mailing Address - Phone:412-231-1783
Mailing Address - Fax:
Practice Address - Street 1:415 E OHIO ST
Practice Address - Street 2:SUITE 275
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15212-5586
Practice Address - Country:US
Practice Address - Phone:412-231-1783
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS019748-L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist