Provider Demographics
NPI:1710943774
Name:SGAMBELLONE, FRANK J (DDS)
Entity Type:Individual
Prefix:DR
First Name:FRANK
Middle Name:J
Last Name:SGAMBELLONE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 OKARA DR
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADTY
Mailing Address - State:NY
Mailing Address - Zip Code:12303
Mailing Address - Country:US
Mailing Address - Phone:518-355-6712
Mailing Address - Fax:
Practice Address - Street 1:71 OKARA DR
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12303-5721
Practice Address - Country:US
Practice Address - Phone:518-355-6712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022051-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00527862Medicaid