Provider Demographics
NPI:1427122753
Name:SO, JOAN (DMD)
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:
Last Name:SO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:JOAN
Other - Middle Name:
Other - Last Name:RAMANAUSKAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1379 HUGUENOT AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312
Mailing Address - Country:US
Mailing Address - Phone:646-226-9750
Mailing Address - Fax:
Practice Address - Street 1:4350 HYLAN BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312
Practice Address - Country:US
Practice Address - Phone:718-317-7211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0414461122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist