Sand Lane Dental PC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

050679 Issued in NY

Legal business name

SAND LANE DENTAL PC

Practice address

128 Sand LN
Staten Island, NY 10305-4543

Phone

(718) 273-5006

Fax

(718) 273-2778

NPI assigned

Feb 2, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Andzhela P Tkachuk, DDS

Title

Director

Phone

(718) 273-5006

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Lyubov Krut, DDS

  • General Practice Dentistry
  • Staten Island, NY
  • NPI 1356331029
  NPD (past)
• Anzhela Tkachuk, DDS

  • General Practice Dentistry
  • Staten Island, NY
  • NPI 1023008786
  NPD (past)
• Igor Tkachuk

  • General Practice Dentistry
  • Staten Island, NY
  • NPI 1568729788
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170374400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1292976000000",
    "number": "1649318601",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "67 CLAWSON ST",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103063222",
            "telephone_number": "718-273-5006",
            "fax_number": "718-273-2778"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "128 SAND LN",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103054543",
            "telephone_number": "718-273-5006",
            "fax_number": "718-273-2778"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAND LANE DENTAL PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-02",
        "last_updated": "2010-12-22",
        "status": "A",
        "authorized_official_last_name": "TKACHUK",
        "authorized_official_first_name": "ANDZHELA",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "718-273-5006",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "050679",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02408771",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02410680",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Elsie Sanchez
• Manuel Sanchez
• Yoali Guadalupe Sanchez
• Ines Sancho Torres, M.D.
• Sanctuary Mental Health Counseling, PLLC
• Sand Lane Drugs Inc
• Sand Lane Pharmacy
• Soe Sandar, MD
• Cheryl Lynn Sanders
• Corisha S Sanders, LMSW

• General Practice Dentistry in Staten Island, NY
• Providers in Staten Island, NY by specialty
• General Practice Dentistry in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.