MEDICARE: FOLEY SQUARE DENTAL, P.C.

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	261QD0000X	Dental Clinic/Center	26089	NY

General Provider Information

NPI Number	:	1548406390
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOLEY SQUARE DENTAL, P.C.

Provider Business Mailing Address
First Line	:	175 MONROE ST
Second Line	:	LOWER LEVEL
City	:	BROOKLYN
State	:	NY
Zip	:	11216-6718
Country	:	US
Telephone Number	:	718-623-6222
Fax Number	:	717-623-6225

Provider Business Practice Location Address
First Line	:	175 MONROE ST
Second Line	:	LOWER LEVEL
City	:	BROOKLYN
State	:	NY
Zip	:	11216-6718
Country	:	US
Telephone Number	:	718-623-6222
Fax Number	:	717-623-6225

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. FREDERICK SANDS
Credential	:	D.D.S.
Telephone Number	:	718-623-6222

Provider Enumeration Date	:	12/29/2008
Last Update Date	:	05/01/2010

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