Provider Demographics
NPI:1528148756
Name:SANDIN, HILDENIA (DMD)
Entity type:Individual
Prefix:
First Name:HILDENIA
Middle Name:
Last Name:SANDIN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:717 WEST 177TH STREET
Mailing Address - Street 2:APT 3
Mailing Address - City:NEW YORK CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10033
Mailing Address - Country:US
Mailing Address - Phone:212-740-0780
Mailing Address - Fax:
Practice Address - Street 1:717 WEST 177TH STREET
Practice Address - Street 2:APT 3
Practice Address - City:NEW YORK CITY
Practice Address - State:NY
Practice Address - Zip Code:10033
Practice Address - Country:US
Practice Address - Phone:212-740-0780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY04023511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00973515Medicaid