MEDICARE: THE GENERAL DENTIST

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	1223P0300X	Periodontics
2	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1407360639
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE GENERAL DENTIST

Provider Business Mailing Address
First Line	:	405 MAIN ST
Second Line	:
City	:	LANDISVILLE
State	:	PA
Zip	:	17538-1812
Country	:	US
Telephone Number	:	717-898-7221
Fax Number	:	717-898-7357

Provider Business Practice Location Address
First Line	:	405 MAIN ST
Second Line	:
City	:	LANDISVILLE
State	:	PA
Zip	:	17538-1812
Country	:	US
Telephone Number	:	717-898-7221
Fax Number	:	717-898-7357

Authorized Official
Title or Position	:	OWNER/DENTIST
Name	:	DR. THOMAS JOSEPH SARDINA
Credential	:	DMD
Telephone Number	:	717-898-7221

Provider Enumeration Date	:	11/27/2017
Last Update Date	:	11/27/2017

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Directions to “THE GENERAL DENTIST ” Practice Location

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