Provider Demographics
NPI: | 1528499365 |
---|---|
Name: | SACHS DENTAL CENTER |
Entity type: | Organization |
Organization Name: | SACHS DENTAL CENTER |
Other - Org Name: | <UNAVAIL> |
Other - Org Type: | |
Authorized Official - Title/Position: | DENTIST |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | RANDY |
Authorized Official - Middle Name: | JAY |
Authorized Official - Last Name: | SACHS |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DMD |
Authorized Official - Phone: | 561-434-3055 |
Mailing Address - Street 1: | 9835-8 LAKE WORTH RD |
Mailing Address - Street 2: | |
Mailing Address - City: | LAKE WORTH |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 33467 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 561-434-3055 |
Mailing Address - Fax: | 561-434-7037 |
Practice Address - Street 1: | 9835-8 LAKE WORTH RD |
Practice Address - Street 2: | |
Practice Address - City: | LAKE WORTH |
Practice Address - State: | FL |
Practice Address - Zip Code: | 33467 |
Practice Address - Country: | US |
Practice Address - Phone: | 561-434-3055 |
Practice Address - Fax: | 561-434-7037 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2013-12-04 |
Last Update Date: | 2013-12-04 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
FL | DN15737 | 1223G0001X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 1223G0001X | Dental Providers | Dentist | General Practice | Group - Single Specialty |