Provider Demographics
NPI:1801056908
Name:SARANDEV, GEORGE (DDS)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:SARANDEV
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:PO BOX 775
Mailing Address - Street 2:
Mailing Address - City:AU SABLE FORKS
Mailing Address - State:NY
Mailing Address - Zip Code:12912-0775
Mailing Address - Country:US
Mailing Address - Phone:518-647-5150
Mailing Address - Fax:518-647-4532
Practice Address - Street 1:30 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:AU SABLE FORKS
Practice Address - State:NY
Practice Address - Zip Code:12912
Practice Address - Country:US
Practice Address - Phone:518-647-5150
Practice Address - Fax:518-647-4532
Is Sole Proprietor?:No
Enumeration Date:2008-06-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0545561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice