MEDICARE: LONG ISLAND ENDODONTICS, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223E0200X	Endodontics	0316031	NY

General Provider Information

NPI Number	:	1427066208
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LONG ISLAND ENDODONTICS, P.C.

Provider Business Mailing Address
First Line	:	141 FRANKLIN PL
Second Line	:	SUITE C
City	:	WOODMERE
State	:	NY
Zip	:	11598-1218
Country	:	US
Telephone Number	:	516-374-3663
Fax Number	:	516-374-4064

Provider Business Practice Location Address
First Line	:	141 FRANKLIN PL
Second Line	:	SUITE C
City	:	WOODMERE
State	:	NY
Zip	:	11598-1218
Country	:	US
Telephone Number	:	516-374-3663
Fax Number	:	516-374-4064

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JOHN LUCIAN SANTOPOLO
Credential	:	D.D.S., M.SC.D.
Telephone Number	:	516-374-3663

Provider Enumeration Date	:	08/04/2006
Last Update Date	:	08/22/2020

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