Healthcare Provider Details

I. General information

NPI: 1275925653
Provider Name (Legal Business Name): HANLON&SANDERS DMD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2015
Last Update Date: 02/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1149 OLD COUNTRY RD SUITE B1
RIVERHEAD NY
11901-2057
US

IV. Provider business mailing address

1149 OLD COUNTRY RD SUITE B1
RIVERHEAD NY
11901-2057
US

V. Phone/Fax

Practice location:
  • Phone: 631-369-0300
  • Fax: 631-369-0300
Mailing address:
  • Phone: 631-369-0300
  • Fax: 631-369-0300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number39244
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number39273
License Number StateNY

VIII. Authorized Official

Name: DR. TERRY MORSE SANDERS
Title or Position: VICE PRESIDENT
Credential: DMD
Phone: 631-369-0300