Provider Demographics
NPI:1003097577
Name:PATRON, SANDRA (DMD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:
Last Name:PATRON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:969G EDGEWATER BLVD # 782
Mailing Address - Street 2:
Mailing Address - City:FOSTER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94404-3760
Mailing Address - Country:US
Mailing Address - Phone:650-520-7756
Mailing Address - Fax:650-627-9536
Practice Address - Street 1:327 N SAN MATEO DR STE 1
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-2585
Practice Address - Country:US
Practice Address - Phone:650-520-7756
Practice Address - Fax:650-627-9536
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-26
Last Update Date:2008-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA365961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice