Provider Demographics
NPI:1982855516
Name:DISANTI, JUDY L (DMD)
Entity Type:Individual
Prefix:DR
First Name:JUDY
Middle Name:L
Last Name:DISANTI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1009 BEAVER GRADE RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CORAOPOLIS
Mailing Address - State:PA
Mailing Address - Zip Code:15108-2969
Mailing Address - Country:US
Mailing Address - Phone:412-264-6229
Mailing Address - Fax:412-264-5035
Practice Address - Street 1:1009 BEAVER GRADE RD
Practice Address - Street 2:SUITE 300
Practice Address - City:CORAOPOLIS
Practice Address - State:PA
Practice Address - Zip Code:15108-2969
Practice Address - Country:US
Practice Address - Phone:412-264-6229
Practice Address - Fax:412-264-5035
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-01
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS025749L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist