Provider Demographics
NPI:1427221142
Name:SANFORD FAMILY DENTAL CARE, P.C.
Entity Type:Organization
Organization Name:SANFORD FAMILY DENTAL CARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:SZUSTER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-939-9090
Mailing Address - Street 1:13317 SANFORD AVE
Mailing Address - Street 2:SUITE LB
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-3642
Mailing Address - Country:US
Mailing Address - Phone:718-939-9090
Mailing Address - Fax:
Practice Address - Street 1:13317 SANFORD AVE
Practice Address - Street 2:SUITE LB
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-3642
Practice Address - Country:US
Practice Address - Phone:718-939-9090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-03
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046429-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01687609Medicaid
NY0017844OtherDORAL IPA