Provider Demographics
NPI:1417309089
Name:UNIVERSAL DENTAL SERVICES, ELMONT PC
Entity Type:Organization
Organization Name:UNIVERSAL DENTAL SERVICES, ELMONT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SANFORD
Authorized Official - Middle Name:
Authorized Official - Last Name:GERBER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:516-775-1212
Mailing Address - Street 1:1561 HEMPSTEAD TPKE
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-2365
Mailing Address - Country:US
Mailing Address - Phone:516-775-1212
Mailing Address - Fax:516-775-6500
Practice Address - Street 1:1561 HEMPSTEAD TPKE
Practice Address - Street 2:
Practice Address - City:ELMONT
Practice Address - State:NY
Practice Address - Zip Code:11003-2365
Practice Address - Country:US
Practice Address - Phone:516-775-1212
Practice Address - Fax:516-775-6500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-07
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032635122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00498999Medicaid