Provider Demographics
NPI:1144247057
Name:STUART H SANDREW DDS MSD INC
Entity type:Organization
Organization Name:STUART H SANDREW DDS MSD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STUART
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:SANDREW
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MSD
Authorized Official - Phone:413-445-4592
Mailing Address - Street 1:435 SOUTH STREET
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201
Mailing Address - Country:US
Mailing Address - Phone:413-445-4592
Mailing Address - Fax:413-445-6756
Practice Address - Street 1:435 SOUTH STREET
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201
Practice Address - Country:US
Practice Address - Phone:413-445-4592
Practice Address - Fax:413-445-6756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA101271223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAX11861OtherBCBS DENTAL
MAX11861OtherBCBS DENTAL