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General NPI Number Information
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NPI Number | 1295898286
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Entity Type | Individual
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Provider Name | JAMES LEONARD DESANTIS DDS & MD
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Gender | Male
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Dates
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Enumeration Date | 12/19/2006
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Last Update Date | 03/28/2018
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Provider Practice Location Address
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Address Line | 535 COLUMBIA DRIVE
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City | JOHNSON CITY
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State | NY
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Zip | 13790
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Country | US
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Telephone | 607-729-5900
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Fax | 607-729-6500
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Provider Business Mailing Address
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Address Line | 535 COLUMBIA DR
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City | JOHNSON CITY
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State | NY
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Zip | 13790-3302
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Country | US
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Telephone | 607-729-5900
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Fax | 607-729-6500
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 048526
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License Number State | NY
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