| Mountainview Oral & Maxillofacial Surgery, P.c. | |
|
535 Columbia Dr Johnson City NY 13790-3302 | |
| (607) 729-5900 | |
| Not Available |
| Full Name | Mountainview Oral & Maxillofacial Surgery, P.c. |
|---|---|
| Speciality | Dentist |
| Location | 535 Columbia Dr, Johnson City, New York |
| Authorized Official Name and Position | James Leonard Desantis (OWNER) |
| Authorized Official Contact | 6077295900 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mountainview Oral & Maxillofacial Surgery, P.c. 535 Columbia Dr Johnson City NY 13790-3302 Ph: (607) 729-5900 | Mountainview Oral & Maxillofacial Surgery, P.c. 535 Columbia Dr Johnson City NY 13790-3302 Ph: (607) 729-5900 |
| NPI Number | 1922278480 |
|---|---|
| Provider Enumeration Date | 03/11/2008 |
| Last Update Date | 03/11/2008 |
| Medicare PECOS PAC ID | 8224012489 |
|---|---|
| Medicare Enrollment ID | O20040615001349 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922278480 | NPI | - | NPPES |
| 02395297 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | 048526-1 (New York) | Primary |
| 174400000X | Specialist | 230001 (New York) | Secondary |
| Provider Name | James L Desantis |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1295898286 PECOS PAC ID: 3375527542 Enrollment ID: I20040623001182 |
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