Provider Demographics
NPI:1093331027
Name:SENSTAD, MARY (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:
Last Name:SENSTAD
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:PO BOX 11
Mailing Address - Street 2:
Mailing Address - City:LA CANADA
Mailing Address - State:CA
Mailing Address - Zip Code:91012-0011
Mailing Address - Country:US
Mailing Address - Phone:818-395-1307
Mailing Address - Fax:
Practice Address - Street 1:20173 SATICOY ST
Practice Address - Street 2:
Practice Address - City:WINNETKA
Practice Address - State:CA
Practice Address - Zip Code:91306-2506
Practice Address - Country:US
Practice Address - Phone:818-717-9066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-25
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA104947122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist