Provider Demographics
NPI:1568478196
Name:SACHEM DENTAL GROUP
Entity Type:Organization
Organization Name:SACHEM DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:GENTILE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-588-8280
Mailing Address - Street 1:469 HAWKINS AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LAKE RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-4276
Mailing Address - Country:US
Mailing Address - Phone:631-588-8280
Mailing Address - Fax:631-588-6258
Practice Address - Street 1:469 HAWKINS AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:LAKE RONKONKOMA
Practice Address - State:NY
Practice Address - Zip Code:11779-4276
Practice Address - Country:US
Practice Address - Phone:631-588-8280
Practice Address - Fax:631-588-6258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty