MEDICARE: DR. PAMELA LYNN SANDS D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry	045021	NY

General Provider Information

NPI Number	:	1255512299
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAMELA LYNN SANDS D.D.S.

Provider Business Mailing Address
First Line	:	3471 LONG BEACH ROAD
Second Line	:
City	:	OCEANSIDE
State	:	NY
Zip	:	11572
Country	:	US
Telephone Number	:	516-536-5800
Fax Number	:	516-208-7447

Provider Business Practice Location Address
First Line	:	2882 LONG BEACH RD
Second Line	:
City	:	OCEANSIDE
State	:	NY
Zip	:	11572-3114
Country	:	US
Telephone Number	:	516-536-5800
Fax Number	:	516-536-3578

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/19/2007
Last Update Date	:	06/02/2016

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