Provider Demographics
NPI:1669795332
Name:SACHEM ORAL SURGERY, PLLC
Entity type:Organization
Organization Name:SACHEM ORAL SURGERY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:AMENEDO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:631-382-8585
Mailing Address - Street 1:110 SMITHTOWN BLVD
Mailing Address - Street 2:
Mailing Address - City:NESCONSET
Mailing Address - State:NY
Mailing Address - Zip Code:11767-1748
Mailing Address - Country:US
Mailing Address - Phone:631-382-8585
Mailing Address - Fax:631-382-8580
Practice Address - Street 1:110 SMITHTOWN BLVD
Practice Address - Street 2:
Practice Address - City:NESCONSET
Practice Address - State:NY
Practice Address - Zip Code:11767-1748
Practice Address - Country:US
Practice Address - Phone:631-382-8585
Practice Address - Fax:631-382-8580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-09
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0505221223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty