Individual
DR. RUSSELL SANDMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD, MS
Contact information
Practice address
17331 JAMAICA AVE, JAMAICA, NY 11432-5523
(718) 291-4441
Mailing address
58 W 58TH ST APT 17D, NEW YORK, NY 10019-2509
(646) 405-5555
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
0515411
NY
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
22DI02309200
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02778912
—
NY
Enumeration date
01/30/2007
Last updated
07/08/2007
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