Individual
DR. JOHN A DESTITO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
206 W THOMAS ST, ROME, NY 13440-5008
(315) 336-9190
(315) 336-3121
Mailing address
206 W THOMAS ST, ROME, NY 13440-5008
(315) 336-9190
(315) 336-3121
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
26896
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00596121
—
NY
Enumeration date
04/08/2007
Last updated
07/09/2007
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