Provider Demographics
NPI:1629763958
Name:JOSEPH LOUIS DESANTIS DDS PC
Entity Type:Organization
Organization Name:JOSEPH LOUIS DESANTIS DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SHAREHOLDER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:DESANTIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-702-7195
Mailing Address - Street 1:216 ROSE AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-2919
Mailing Address - Country:US
Mailing Address - Phone:718-702-7195
Mailing Address - Fax:718-980-9175
Practice Address - Street 1:216 ROSE AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-2919
Practice Address - Country:US
Practice Address - Phone:718-702-7195
Practice Address - Fax:718-980-9175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-11
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty