Provider Demographics
NPI:1710050489
Name:DILASCIO, JAMES PATRICK (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:PATRICK
Last Name:DILASCIO
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 1:422 STUYVESANT AVE
Mailing Address - Street 2:
Mailing Address - City:LYNDHURST
Mailing Address - State:NJ
Mailing Address - Zip Code:07071-2326
Mailing Address - Country:US
Mailing Address - Phone:201-935-4577
Mailing Address - Fax:201-935-8893
Practice Address - Street 1:422 STUYVESANT AVE
Practice Address - Street 2:
Practice Address - City:LYNDHURST
Practice Address - State:NJ
Practice Address - Zip Code:07071-2326
Practice Address - Country:US
Practice Address - Phone:201-935-4577
Practice Address - Fax:201-935-8893
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ092271223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
457068QL8OtherDR DILASCIO MEDICARE PIN
058001OtherPIN
X72996Medicare UPIN
457068QL8OtherDR DILASCIO MEDICARE PIN
T77594Medicare UPIN