Provider Demographics
NPI:1558472142
Name:SANTOMAURO, THOMAS L (MD, DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:L
Last Name:SANTOMAURO
Suffix:
Gender:M
Credentials:MD, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7505 FORT HAMILTON PKWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11228-2305
Mailing Address - Country:US
Mailing Address - Phone:718-745-7400
Mailing Address - Fax:718-745-3401
Practice Address - Street 1:7505 FORT HAMILTON PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11228-2305
Practice Address - Country:US
Practice Address - Phone:718-745-7400
Practice Address - Fax:718-745-3401
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0307691223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00659590Medicaid
NY00659590Medicaid