MEDICARE: HILDENIA SANDIN DMD

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	1223G0001X	General Practice Dentistry	0402351	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	:	1528148756
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HILDENIA SANDIN DMD

Provider Business Mailing Address
First Line	:	717 WEST 177TH STREET
Second Line	:	APT 3
City	:	NEW YORK CITY
State	:	NY
Zip	:	10033
Country	:	US
Telephone Number	:	212-740-0780
Fax Number	:

Provider Business Practice Location Address
First Line	:	717 WEST 177TH STREET
Second Line	:	APT 3
City	:	NEW YORK CITY
State	:	NY
Zip	:	10033
Country	:	US
Telephone Number	:	212-740-0780
Fax Number	:

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

Provider Enumeration Date	:	10/16/2006
Last Update Date	:	07/08/2007

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