Provider Demographics
NPI:1386123172
Name:SARANDEVA GIESBERG, KONSTANTINA K (DDS)
Entity type:Individual
Prefix:MRS
First Name:KONSTANTINA
Middle Name:K
Last Name:SARANDEVA GIESBERG
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 1:245 N MAIN ST UNIT 453
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-7541
Mailing Address - Country:US
Mailing Address - Phone:646-647-9090
Mailing Address - Fax:
Practice Address - Street 1:371 GRAPHIC BLVD
Practice Address - Street 2:
Practice Address - City:NEW MILFORD
Practice Address - State:NJ
Practice Address - Zip Code:07646-2128
Practice Address - Country:US
Practice Address - Phone:646-647-9090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-13
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0012691223D0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0004XDental ProvidersDentistDental Anesthesiology