Provider Demographics
NPI:1508136755
Name:SANDSTONE FAMILY DENTISTRY, P.C.
Entity Type:Organization
Organization Name:SANDSTONE FAMILY DENTISTRY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:M
Authorized Official - Last Name:HOWLETT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:315-265-5344
Mailing Address - Street 1:150 ELM ST
Mailing Address - Street 2:
Mailing Address - City:POTSDAM
Mailing Address - State:NY
Mailing Address - Zip Code:13676-3300
Mailing Address - Country:US
Mailing Address - Phone:315-265-5344
Mailing Address - Fax:315-261-4799
Practice Address - Street 1:150 ELM ST
Practice Address - Street 2:
Practice Address - City:POTSDAM
Practice Address - State:NY
Practice Address - Zip Code:13676-3300
Practice Address - Country:US
Practice Address - Phone:315-265-5344
Practice Address - Fax:315-261-4799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047783-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01872839Medicaid