Provider Demographics
NPI:1508977935
Name:SZUSTER, SANDRA MARCELA (DDS)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:MARCELA
Last Name:SZUSTER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 STATION RD
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11023-2417
Mailing Address - Country:US
Mailing Address - Phone:718-939-9090
Mailing Address - Fax:718-909-9090
Practice Address - Street 1:13317 SANFORD AVE APT LB
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-3609
Practice Address - Country:US
Practice Address - Phone:718-939-9090
Practice Address - Fax:718-909-9090
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046429-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01687609Medicaid