Provider Demographics
NPI:1154339190
Name:PANTINO, DON A (DDSPC)
Entity type:Individual
Prefix:
First Name:DON
Middle Name:A
Last Name:PANTINO
Suffix:
Gender:M
Credentials:DDSPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11751-0435
Mailing Address - Country:US
Mailing Address - Phone:631-581-7777
Mailing Address - Fax:631-581-2777
Practice Address - Street 1:309 MAIN STREET
Practice Address - Street 2:
Practice Address - City:ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11751-0435
Practice Address - Country:US
Practice Address - Phone:631-581-7777
Practice Address - Fax:631-581-2777
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY03395211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5536310001Medicare NSC