Provider Demographics
NPI:1215925557
Name:SITHOLE, WILSON DANDATO (DDS MPH)
Entity type:Individual
Prefix:DR
First Name:WILSON
Middle Name:DANDATO
Last Name:SITHOLE
Suffix:
Gender:M
Credentials:DDS MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6846 BUCKLEY ROAD
Mailing Address - Street 2:SALINA FAMILY DENTAL PLLC
Mailing Address - City:NORTH SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13212
Mailing Address - Country:US
Mailing Address - Phone:315-457-7393
Mailing Address - Fax:315-457-7396
Practice Address - Street 1:6846 BUCKLEY ROAD
Practice Address - Street 2:SALINA FAMILY DENTAL PLLC
Practice Address - City:NORTH SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13212
Practice Address - Country:US
Practice Address - Phone:315-457-7393
Practice Address - Fax:315-457-7396
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY03050011223G0001X
DC28261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02512852Medicaid