NPI 1225448855

Michael John Desivo, DDS

Practitioner General Practice Dentistry East Islip, NY

Practice location

Address: 228 East Main St, East Islip, NY 11730
Phone: (631) 983-6281
Fax: (631) 581-8603

Registered specialties

General Practice Dentistry Primary

Dental Providers Taxonomy 1223G0001X Licence 057983-1 (NY)

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Registry record

NPI: 1225448855
Entity type: Individual
Sex (as registered): Male
NPI issued: 5 May 2014
Record last updated: 11 Apr 2017

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.