Provider Demographics
NPI:1568524379
Name:ESPOSITO, JOHN G JR (DDS FACD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:G
Last Name:ESPOSITO
Suffix:JR
Gender:M
Credentials:DDS FACD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:554 LARKFIELD ROAD
Mailing Address - Street 2:SUITE 10B
Mailing Address - City:EAST NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731
Mailing Address - Country:US
Mailing Address - Phone:631-368-9331
Mailing Address - Fax:631-368-1397
Practice Address - Street 1:554 LARKFIELD ROAD
Practice Address - Street 2:SUITE 10B
Practice Address - City:EAST NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11731
Practice Address - Country:US
Practice Address - Phone:631-368-9331
Practice Address - Fax:631-368-1397
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY02637911223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery