Organization
MOUNTAINVIEW ORAL & MAXILLOFACIAL SURGERY, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAMES LEONARD DESANTIS M.D., DDS (OWNER)
(607) 729-5900
Entity
Organization
Contact information
Practice address
535 COLUMBIA DR, JOHNSON CITY, NY 13790-3302
(607) 729-5900
Mailing address
535 COLUMBIA DR, JOHNSON CITY, NY 13790-3302
(607) 729-5900
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
048526-1
NY
174400000X
Specialist
230001
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02395297
—
NY
Enumeration date
03/11/2008
Last updated
03/11/2008
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