Individual
DR. JOHN EDWARD FANTASIA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
27005 76TH AVE, LIJMC, NEW HYDE PARK, NY 11040-1433
(718) 470-7116
(718) 347-3483
Mailing address
27005 76TH AVE, LIJMC, NEW HYDE PARK, NY 11040-1433
(718) 470-7116
(718) 347-3483
Taxonomy
Speciality
Code
Description
License number
State
1223P0106X
Oral and Maxillofacial Pathology Dentistry
Primary
041799-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01098053
—
NY
Enumeration date
11/07/2006
Last updated
07/08/2007
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