Healthcare Provider Details

I. General information

NPI: 1386990828
Provider Name (Legal Business Name): ANDREW SACKSERDDS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2012
Last Update Date: 08/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 MINEOLA BLVD
MINEOLA NY
11501-3974
US

IV. Provider business mailing address

140 MINEOLA BLVD
MINEOLA NY
11501-3974
US

V. Phone/Fax

Practice location:
  • Phone: 516-248-6018
  • Fax:
Mailing address:
  • Phone: 516-248-6018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number State

VIII. Authorized Official

Name: DR. ANDREW N. SACKSER
Title or Position: ORGANIZER
Credential: D.D.S
Phone: 516-248-6018