Healthcare Provider Details

I. General information

NPI: 1255512299
Provider Name (Legal Business Name): PAMELA LYNN SANDS D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PAMELA LYNN SAMORODIN D.D.S.

II. Dates (important events)

Enumeration Date: 11/19/2007
Last Update Date: 06/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2882 LONG BEACH RD
OCEANSIDE NY
11572-3114
US

IV. Provider business mailing address

3471 LONG BEACH ROAD
OCEANSIDE NY
11572
US

V. Phone/Fax

Practice location:
  • Phone: 516-536-5800
  • Fax: 516-536-3578
Mailing address:
  • Phone: 516-536-5800
  • Fax: 516-208-7447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number045021
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: