Provider Demographics
NPI:1225396682
Name:SASHA CEKADA DDS P C
Entity Type:Organization
Organization Name:SASHA CEKADA DDS P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SASHA
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:CEKADA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:631-598-2940
Mailing Address - Street 1:193 BROADWAY
Mailing Address - Street 2:SUITE 2
Mailing Address - City:AMITYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11701-2761
Mailing Address - Country:US
Mailing Address - Phone:631-598-2940
Mailing Address - Fax:631-598-8287
Practice Address - Street 1:193 BROADWAY
Practice Address - Street 2:SUITE 2
Practice Address - City:AMITYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11701-2761
Practice Address - Country:US
Practice Address - Phone:631-598-2940
Practice Address - Fax:631-598-8287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-23
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049684122300000X
332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Single Specialty