MEDICARE: SANDRA LISA KAPLAN D.D.S.

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	122300000X	Dentist	043422	NY

General Provider Information

NPI Number	:	1417173535
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA LISA KAPLAN D.D.S.

Provider Business Mailing Address
First Line	:	2936 HYLAN BLVD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10306-4056
Country	:	US
Telephone Number	:	718-987-6453
Fax Number	:	718-980-4588

Provider Business Practice Location Address
First Line	:	2936 HYLAN BLVD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10306-4056
Country	:	US
Telephone Number	:	718-987-6453
Fax Number	:	718-980-4588

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

Provider Enumeration Date	:	04/17/2007
Last Update Date	:	07/08/2007

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