Provider Demographics
NPI:1083029664
Name:COLEY, SANDRA M (DDS)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:M
Last Name:COLEY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1103 KATHRYN RD
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-2173
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1251 SARATOGA AVE NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20018-1025
Practice Address - Country:US
Practice Address - Phone:202-832-8818
Practice Address - Fax:202-548-8600
Is Sole Proprietor?:No
Enumeration Date:2014-06-23
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15574122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD080184400Medicaid