Provider Demographics
NPI:1417020835
Name:SACKSER, ANDREW NOAH (DDS)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:NOAH
Last Name:SACKSER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 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:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0505601122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist