Provider Demographics
NPI:1548406390
Name:FOLEY SQUARE DENTAL, P.C.
Entity Type:Organization
Organization Name:FOLEY SQUARE DENTAL, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-623-6222
Mailing Address - Street 1:175 MONROE ST
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11216-6718
Mailing Address - Country:US
Mailing Address - Phone:718-623-6222
Mailing Address - Fax:717-623-6225
Practice Address - Street 1:175 MONROE ST
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11216-6718
Practice Address - Country:US
Practice Address - Phone:718-623-6222
Practice Address - Fax:717-623-6225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-29
Last Update Date:2010-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY26089261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY=========OtherITIN