Provider Demographics
NPI:1881782456
Name:LAFOCA, SANTO (DMD)
Entity type:Individual
Prefix:DR
First Name:SANTO
Middle Name:
Last Name:LAFOCA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PITTSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18640-1806
Mailing Address - Country:US
Mailing Address - Phone:570-655-3040
Mailing Address - Fax:570-655-5634
Practice Address - Street 1:20 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PITTSTON
Practice Address - State:PA
Practice Address - Zip Code:18640-1806
Practice Address - Country:US
Practice Address - Phone:570-655-3040
Practice Address - Fax:570-655-5634
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS027282L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016107660003Medicaid