Provider Demographics
NPI:1447816475
Name:MERCY DENTAL LLC
Entity type:Organization
Organization Name:MERCY DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OF MERCY DENTAL LLC
Authorized Official - Prefix:DR
Authorized Official - First Name:DRAGOS
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDULESCU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:516-208-5501
Mailing Address - Street 1:2000 NORTH VILLAGE AVENUE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570
Mailing Address - Country:US
Mailing Address - Phone:516-208-5501
Mailing Address - Fax:888-869-5047
Practice Address - Street 1:2000 NORTH VILLAGE AVENUE
Practice Address - Street 2:SUITE 206
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570
Practice Address - Country:US
Practice Address - Phone:516-208-5501
Practice Address - Fax:888-869-5047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-15
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty