Provider Demographics
NPI:1356418164
Name:DESANTIS, THOMAS SAMUEL (DMD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:SAMUEL
Last Name:DESANTIS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 FORT COUCH ROAD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15241
Mailing Address - Country:US
Mailing Address - Phone:412-833-4222
Mailing Address - Fax:412-833-5332
Practice Address - Street 1:110 FORT COUCH ROAD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15241
Practice Address - Country:US
Practice Address - Phone:412-833-4222
Practice Address - Fax:412-833-5332
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS24050L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice