Provider Demographics
NPI:1831300458
Name:FINOCCHIO, JOHN P (DDS)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:P
Last Name:FINOCCHIO
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 1:50 DANTE AVENUE
Mailing Address - Street 2:
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801-6352
Mailing Address - Country:US
Mailing Address - Phone:576-735-8803
Mailing Address - Fax:
Practice Address - Street 1:50 DANTE AVENUE
Practice Address - Street 2:
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-6352
Practice Address - Country:US
Practice Address - Phone:576-735-8803
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029211122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01957359Medicaid