Provider Demographics
NPI:1013576032
Name:SANFORD, AILIE JOY (DDS)
Entity Type:Individual
Prefix:DR
First Name:AILIE
Middle Name:JOY
Last Name:SANFORD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:AILIE
Other - Middle Name:JOY
Other - Last Name:POWERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8140 N HICKORY ST APT 11-013
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64118-6421
Mailing Address - Country:US
Mailing Address - Phone:816-204-7673
Mailing Address - Fax:
Practice Address - Street 1:141 COMMUNICATION DR
Practice Address - Street 2:
Practice Address - City:HANNIBAL
Practice Address - State:MO
Practice Address - Zip Code:63401-3670
Practice Address - Country:US
Practice Address - Phone:573-603-1460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-12
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20190203341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice