Provider Demographics
NPI:1225373855
Name:SAUER, KERRY J (DDS)
Entity Type:Individual
Prefix:DR
First Name:KERRY
Middle Name:J
Last Name:SAUER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 VAN COTT RD
Mailing Address - Street 2:SUITE 1W
Mailing Address - City:DEER PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11729-6519
Mailing Address - Country:US
Mailing Address - Phone:631-242-5329
Mailing Address - Fax:631-254-1967
Practice Address - Street 1:16 VAN COTT RD
Practice Address - Street 2:SUITE 1W
Practice Address - City:DEER PARK
Practice Address - State:NY
Practice Address - Zip Code:11729-6519
Practice Address - Country:US
Practice Address - Phone:631-242-5329
Practice Address - Fax:631-254-1967
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-08
Last Update Date:2016-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049787-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist