Provider Demographics
NPI:1740370956
Name:MORMINO, JOSEPH T (DDS)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:T
Last Name:MORMINO
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 1:104 WINDSOR RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-4541
Mailing Address - Country:US
Mailing Address - Phone:718-876-9100
Mailing Address - Fax:718-876-8888
Practice Address - Street 1:104 WINDSOR RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-4541
Practice Address - Country:US
Practice Address - Phone:718-876-9100
Practice Address - Fax:718-876-8888
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0424341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice