| Sand Lane Dental Pc | |
|
128 Sand Ln Staten Island NY 10305-4543 | |
| (718) 273-5006 | |
| (718) 273-2778 |
| Full Name | Sand Lane Dental Pc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 128 Sand Ln, Staten Island, New York |
| Authorized Official Name and Position | Andzhela P Tkachuk (DIRECTOR) |
| Authorized Official Contact | 7182735006 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Sand Lane Dental Pc 67 Clawson St Staten Island NY 10306-3222 Ph: (718) 273-5006 | Sand Lane Dental Pc 128 Sand Ln Staten Island NY 10305-4543 Ph: (718) 273-5006 |
| NPI Number | 1649318601 |
|---|---|
| Provider Enumeration Date | 02/02/2007 |
| Last Update Date | 12/22/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649318601 | NPI | - | NPPES |
| 02408771 | Medicaid | NY | |
| 02410680 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 050679 (New York) | Primary |
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