Individual
DR. DANIEL E DISTASI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
700 BROADWAY STE 64, WESTWOOD, NJ 07675-1674
(201) 666-1300
(201) 666-2055
Mailing address
200 W 57TH ST STE 410, NEW YORK, NY 10019-3211
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
22DI01442602
NJ
Other
Enumeration date
10/03/2006
Last updated
07/08/2007
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