Provider Demographics
NPI:1588008346
Name:DOSSANTOS, CELESTINO MARQUES (DMD)
Entity Type:Individual
Prefix:DR
First Name:CELESTINO
Middle Name:MARQUES
Last Name:DOSSANTOS
Suffix:
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 1:175 JERICHO TPKE
Mailing Address - Street 2:SUITE 307A
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-4532
Mailing Address - Country:US
Mailing Address - Phone:516-921-4141
Mailing Address - Fax:516-921-4148
Practice Address - Street 1:175 JERICHO TPKE
Practice Address - Street 2:SUITE 307A
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791-4532
Practice Address - Country:US
Practice Address - Phone:516-921-4141
Practice Address - Fax:516-921-4148
Is Sole Proprietor?:No
Enumeration Date:2013-04-24
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048052122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist