Provider Demographics
NPI:1700050382
Name:SQUATRITO, PHILIP JOHN (DDS)
Entity Type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:JOHN
Last Name:SQUATRITO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 ANNADALE RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-1569
Mailing Address - Country:US
Mailing Address - Phone:718-948-1600
Mailing Address - Fax:
Practice Address - Street 1:142 ANNADALE RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-1569
Practice Address - Country:US
Practice Address - Phone:718-948-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-15
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053918-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice