Provider Demographics
NPI:1336671049
Name:AUSABLE DENTAL CENTER
Entity Type:Organization
Organization Name:AUSABLE DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:K
Authorized Official - Last Name:SARANDEV
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:518-647-5150
Mailing Address - Street 1:PO BOX 775
Mailing Address - Street 2:
Mailing Address - City:AU SABLE FORKS
Mailing Address - State:NY
Mailing Address - Zip Code:12912-0775
Mailing Address - Country:US
Mailing Address - Phone:518-647-5150
Mailing Address - Fax:518-647-4532
Practice Address - Street 1:30 N MAIN ST
Practice Address - Street 2:
Practice Address - City:AU SABLE FORKS
Practice Address - State:NY
Practice Address - Zip Code:12912
Practice Address - Country:US
Practice Address - Phone:518-647-5150
Practice Address - Fax:518-647-4532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-31
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY054556-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty