Provider Demographics
NPI:1124122668
Name:DESANTI, MICHAEL M JR (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:M
Last Name:DESANTI
Suffix:JR
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 1:22 HEDGEROSE LN
Mailing Address - Street 2:
Mailing Address - City:DELMAR
Mailing Address - State:NY
Mailing Address - Zip Code:12054-2467
Mailing Address - Country:US
Mailing Address - Phone:518-478-9772
Mailing Address - Fax:
Practice Address - Street 1:554 SAND CREEK RD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-2433
Practice Address - Country:US
Practice Address - Phone:518-869-5397
Practice Address - Fax:518-869-5399
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0493631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice