MEDICARE: UNIVERSAL DENTAL SERVICES, ELMONT PC

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	032635	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417309089
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSAL DENTAL SERVICES, ELMONT PC

Provider Business Mailing Address
First Line	:	1561 HEMPSTEAD TPKE
Second Line	:
City	:	ELMONT
State	:	NY
Zip	:	11003-2365
Country	:	US
Telephone Number	:	516-775-1212
Fax Number	:	516-775-6500

Provider Business Practice Location Address
First Line	:	1561 HEMPSTEAD TPKE
Second Line	:
City	:	ELMONT
State	:	NY
Zip	:	11003-2365
Country	:	US
Telephone Number	:	516-775-1212
Fax Number	:	516-775-6500

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SANFORD GERBER
Credential	:	DDS
Telephone Number	:	516-775-1212

Provider Enumeration Date	:	07/07/2016
Last Update Date	:	07/07/2016

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