Provider Demographics
NPI:1194945295
Name:REISS, SARAH (DDS)
Entity type:Individual
Prefix:DR
First Name:SARAH
Middle Name:
Last Name:REISS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1365 VAN ANTWERP RD
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12309-4441
Mailing Address - Country:US
Mailing Address - Phone:518-641-1577
Mailing Address - Fax:518-393-8606
Practice Address - Street 1:1365 VAN ANTWERP RD
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12309-4441
Practice Address - Country:US
Practice Address - Phone:518-641-1577
Practice Address - Fax:518-393-8606
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-30
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0436331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00357548Medicaid
NY00357548Medicaid