Provider Demographics
NPI:1275925653
Name:HANLON&SANDERS DMD PC
Entity Type:Organization
Organization Name:HANLON&SANDERS DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:MORSE
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:631-369-0300
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-23
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY392441223G0001X
NY392731223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty