Provider Demographics
NPI:1689890980
Name:GENAO, SANDRA A (DDS)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:A
Last Name:GENAO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4407 30TH AVE
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11103-2117
Mailing Address - Country:US
Mailing Address - Phone:718-728-9800
Mailing Address - Fax:718-728-7010
Practice Address - Street 1:4407 30TH AVE
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11103-2117
Practice Address - Country:US
Practice Address - Phone:718-728-9800
Practice Address - Fax:718-728-7010
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046954122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist