| Santa Locascio Dds Pc | |
|
7016 Fresh Pond Rd Ridgewood NY 11385-5902 | |
| (718) 628-6588 | |
| (718) 628-9579 |
| Full Name | Santa Locascio Dds Pc |
|---|---|
| Speciality | Dentist |
| Location | 7016 Fresh Pond Rd, Ridgewood, New York |
| Authorized Official Name and Position | Santa Locascio (AUTHORIZED OFFICIAL) |
| Authorized Official Contact | 7186286588 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Santa Locascio Dds Pc 70-16 Fresh Pond Rd Ridgewood NY 11414 Ph: (718) 628-6588 | Santa Locascio Dds Pc 7016 Fresh Pond Rd Ridgewood NY 11385-5902 Ph: (718) 628-6588 |
| NPI Number | 1326018300 |
|---|---|
| Provider Enumeration Date | 01/24/2006 |
| Last Update Date | 04/11/2017 |
| Medicare PECOS PAC ID | 0547571242 |
|---|---|
| Medicare Enrollment ID | O20150623000121 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326018300 | NPI | - | NPPES |
| 01197731 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
| Provider Name | Santa Locascio |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1801112495 PECOS PAC ID: 0648582080 Enrollment ID: I20150629000323 |
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