Provider Demographics
NPI:1073305678
Name:SANDEFUR, CIARA (DMD)
Entity type:Individual
Prefix:
First Name:CIARA
Middle Name:
Last Name:SANDEFUR
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 1:5290 DEATSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:COXS CREEK
Mailing Address - State:KY
Mailing Address - Zip Code:40013-8828
Mailing Address - Country:US
Mailing Address - Phone:502-492-2343
Mailing Address - Fax:
Practice Address - Street 1:3015 WILSON AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40211-1969
Practice Address - Country:US
Practice Address - Phone:502-774-4401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-20
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY113391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice