Provider Demographics
NPI:1457335960
Name:SACKS, SHELDEN NOAH (DMD)
Entity Type:Individual
Prefix:DR
First Name:SHELDEN
Middle Name:NOAH
Last Name:SACKS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5752 GAUGUIN TERRACE
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33418-5612
Mailing Address - Country:US
Mailing Address - Phone:315-317-0125
Mailing Address - Fax:
Practice Address - Street 1:5752 GAUGUIN TERRACE
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33418
Practice Address - Country:US
Practice Address - Phone:315-317-0125
Practice Address - Fax:315-592-4760
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-30
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033762122300000X
FLDN8258122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY576870Medicaid
993762OtherDELTA DENTAL
993762OtherDELTA DENTAL