Provider Demographics
NPI:1346430840
Name:SANDAU, GEORGE WILLIAM (DMD, MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:WILLIAM
Last Name:SANDAU
Suffix:
Gender:M
Credentials:DMD, MD
Other - Prefix:DR
Other - First Name:GEORGE
Other - Middle Name:WILLIAM
Other - Last Name:SANDAU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD, MD, LLC
Mailing Address - Street 1:992 MANTUA PIKE
Mailing Address - Street 2:STE 302
Mailing Address - City:WOODBURY HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:08097-1249
Mailing Address - Country:US
Mailing Address - Phone:732-625-2244
Mailing Address - Fax:732-625-1244
Practice Address - Street 1:15 SCHOOL RD E
Practice Address - Street 2:
Practice Address - City:MARLBORO
Practice Address - State:NJ
Practice Address - Zip Code:07746-2062
Practice Address - Country:US
Practice Address - Phone:732-625-2244
Practice Address - Fax:732-625-1244
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-31
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI021956081223S0112X
NJDIO2195600122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
No122300000XDental ProvidersDentistGroup - Single Specialty