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General NPI Number Information
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NPI Number | 1124289533
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Entity Type | Organization
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Legal Business Name | SAM'S FAMILY DENTAL
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Dates
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Enumeration Date | 06/18/2008
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Last Update Date | 06/18/2008
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Provider Practice Location Address
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Address Line | 39-79 61 STREET ROOSEVELT AVENUE
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City | WOODSIDE
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State | NY
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Zip | 11377
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Country | US
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Telephone | 718-429-5256
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Fax |
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Provider Business Mailing Address
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Address Line | 39-79 61ST STREET ROOSEVELT AVENUE
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City | WOODSIDE
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State | NY
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Zip | 11377
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Country | US
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Telephone | 718-429-5256
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. SANDEEP BHAGAT
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Credential | DMD
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Telephone | 718-429-5256
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 048767
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License Number State | NY
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