Provider Demographics
NPI:1326620212
Name:DESANTO, ANNEMARIE JEAN (DMD)
Entity type:Individual
Prefix:
First Name:ANNEMARIE
Middle Name:JEAN
Last Name:DESANTO
Suffix:
Gender:
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83221 553 AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:NE
Mailing Address - Zip Code:68748-6558
Mailing Address - Country:US
Mailing Address - Phone:402-992-4322
Mailing Address - Fax:
Practice Address - Street 1:5001 SERGEANT RD STE 15
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51106-4777
Practice Address - Country:US
Practice Address - Phone:712-239-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-21
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDD1317122300000X
IA261151223G0001X
390200000X
IADDS-09953122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program