Individual provider Active NPI

Sara Desantis, D.D.S.

  • Periodontics
  • Islip, NY
National Provider Identifier
1528081072
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
PeriodonticsTaxonomy code 1223P0300X
License
048592-1 Issued in NY
Practice address
150 Islip Ave
Suite 11
Islip, NY 11751-3222
Phone
(631) 581-3100
NPI assigned
Jul 25, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Periodontics 1223P0300X 048592-1 NY Primary

Addresses

Primary practice location

150 Islip Ave
Suite 11
Islip, NY 11751-3222

Mailing address

14 Scenicview Cres
Manorville, NY 11949-2978
Phone (631) 909-1787

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
048592-1NYMDPeriodontist

Practice roles

OrganizationSpecialtyStatusNew patients
Kathleen M. Frost, DDS PC Periodontics PastSince Jan 17, 2021 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153785600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1528081072",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14 SCENICVIEW CRES",
            "city": "MANORVILLE",
            "state": "NY",
            "postal_code": "119492978",
            "telephone_number": "631-909-1787"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 ISLIP AVE",
            "address_2": "SUITE 11",
            "city": "ISLIP",
            "state": "NY",
            "postal_code": "117513222",
            "telephone_number": "631-581-3100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DESANTIS",
        "first_name": "SARA",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-07-25",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "NY",
            "license": "048592-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Islip, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.