Provider Demographics
NPI:1700279239
Name:COMMACK DENTAL DESIGN PLLC
Entity Type:Organization
Organization Name:COMMACK DENTAL DESIGN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SAKHAEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:516-647-4055
Mailing Address - Street 1:283 COMMACK RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-6021
Mailing Address - Country:US
Mailing Address - Phone:516-647-4055
Mailing Address - Fax:
Practice Address - Street 1:283 COMMACK RD
Practice Address - Street 2:SUITE 120
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-6021
Practice Address - Country:US
Practice Address - Phone:516-647-4055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-09
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1223E0200X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty