Provider Demographics
NPI:1073393245
Name:BRIAN G SANFORD, DDS., LTD
Entity Type:Organization
Organization Name:BRIAN G SANFORD, DDS., LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING TEAM LEAD
Authorized Official - Prefix:
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA-ROCHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-869-3789
Mailing Address - Street 1:2551 N GREEN VALLEY PKWY STE C301
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-0272
Mailing Address - Country:US
Mailing Address - Phone:702-451-8181
Mailing Address - Fax:702-451-1766
Practice Address - Street 1:2551 N GREEN VALLEY PKWY STE C301
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-0272
Practice Address - Country:US
Practice Address - Phone:702-451-8181
Practice Address - Fax:702-451-1766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-04
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty