Provider Demographics
NPI:1609152743
Name:SCIBETTA, SANDRA SOPHIA (DDS)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:SOPHIA
Last Name:SCIBETTA
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 1:91 COPPERLEAF TER
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-1115
Mailing Address - Country:US
Mailing Address - Phone:917-299-0027
Mailing Address - Fax:
Practice Address - Street 1:91 COPPERLEAF TER
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-1115
Practice Address - Country:US
Practice Address - Phone:917-299-0027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-02
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0512231223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics