Provider Demographics
NPI:1164572921
Name:SANDERS, TERRY MORSE (DMD)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:MORSE
Last Name:SANDERS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1149 OLD COUNTRY RD
Mailing Address - Street 2:SUITE B1
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901-2057
Mailing Address - Country:US
Mailing Address - Phone:631-369-0300
Mailing Address - Fax:631-369-0300
Practice Address - Street 1:1149 OLD COUNTRY RD
Practice Address - Street 2:SUITE B1
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-2057
Practice Address - Country:US
Practice Address - Phone:631-369-0300
Practice Address - Fax:631-369-0300
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY392441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00884024Medicaid