MEDICARE: DR. SARAH MICHELLE GAYLE DDS

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	1223G0001X	General Practice Dentistry	11285	CT
2	122300000X	Dentist	050393-1	NY

General Provider Information

NPI Number	:	1619967585
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SARAH MICHELLE GAYLE DDS

Provider Business Mailing Address
First Line	:	PO BOX 487
Second Line	:
City	:	HARTSDALE
State	:	NY
Zip	:	10530-0487
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1205 E 233RD ST
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10466-3344
Country	:	US
Telephone Number	:	914-843-5957
Fax Number	:

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

Provider Enumeration Date	:	10/24/2005
Last Update Date	:	11/01/2023

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