Provider Demographics
NPI:1386990828
Name:ANDREW SACKSERDDS PLLC
Entity type:Organization
Organization Name:ANDREW SACKSERDDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORGANIZER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:N
Authorized Official - Last Name:SACKSER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:516-248-6018
Mailing Address - Street 1:140 MINEOLA BLVD
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-3974
Mailing Address - Country:US
Mailing Address - Phone:516-248-6018
Mailing Address - Fax:
Practice Address - Street 1:140 MINEOLA BLVD
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-3974
Practice Address - Country:US
Practice Address - Phone:516-248-6018
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-02
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
No124Q00000XDental ProvidersDental HygienistGroup - Multi-Specialty