Provider Demographics
NPI:1033210208
Name:SANDLIN, PATRICK BRYAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:BRYAN
Last Name:SANDLIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 SUNRISE AVE STE 120A
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-4540
Mailing Address - Country:US
Mailing Address - Phone:916-783-0471
Mailing Address - Fax:916-783-0484
Practice Address - Street 1:720 SUNRISE AVE
Practice Address - Street 2:SUITE 120A
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-4516
Practice Address - Country:US
Practice Address - Phone:916-783-0471
Practice Address - Fax:916-783-0484
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA235571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice