Provider Demographics
NPI:1699861724
Name:DISANTI, ANTHONY (DDS)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:
Last Name:DISANTI
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 1:280 MIDDLE COUNTRY RD STE K
Mailing Address - Street 2:
Mailing Address - City:SELDEN
Mailing Address - State:NY
Mailing Address - Zip Code:11784-2532
Mailing Address - Country:US
Mailing Address - Phone:631-732-9000
Mailing Address - Fax:631-736-7982
Practice Address - Street 1:280 MIDDLE COUNTRY RD STE K
Practice Address - Street 2:
Practice Address - City:SELDEN
Practice Address - State:NY
Practice Address - Zip Code:11784-2532
Practice Address - Country:US
Practice Address - Phone:631-732-9000
Practice Address - Fax:631-736-7982
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0364841223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics