Provider Demographics
NPI:1245504984
Name:COSTANDI, JOHN JOSEPH (DMD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:JOSEPH
Last Name:COSTANDI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:JOHN
Other - Middle Name:JOSEPH SHOKRY
Other - Last Name:COSTANDI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:17411 HORACE HARDING EXPY
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11365-1527
Mailing Address - Country:US
Mailing Address - Phone:718-670-1060
Mailing Address - Fax:
Practice Address - Street 1:17411 HORACE HARDING EXPY
Practice Address - Street 2:
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11365-1527
Practice Address - Country:US
Practice Address - Phone:718-670-1060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-27
Last Update Date:2019-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0597451223S0112X
CADDS1037361223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery