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General NPI Number Information
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NPI Number | 1700600889
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Entity Type | Organization
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Legal Business Name | JOSEPH C DISANO DDS LLC
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Dates
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Enumeration Date | 11/14/2024
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Last Update Date | 11/14/2024
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Provider Practice Location Address
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Address Line | 24 SALT POND RD E3
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City | WAKEFIELD
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State | RI
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Zip | 02879
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Country | US
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Telephone | 401-783-4929
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Fax | 401-792-8568
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Provider Business Mailing Address
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Address Line | 24 SALT POND RD SUITE D1
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City | WAKEFIELD
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State | RI
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Zip | 02879
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Country | US
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Telephone | 401-783-4929
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Fax | 401-792-8568
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Authorized Official
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Title or Position | OWNER
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Name | JOSEPH C DISANO
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Credential | DDS
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Telephone | 401-783-1530
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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